THE HEMODYNAMIC AND HEMATOLOGIC EFFECTS OF CIGARETTE-SMOKING VERSUS ANICOTINE PATCH

Patients who smoke have higher complication rates than nonsmokers in t he postoperative period. The authors designed an experimental protocol for habitual smokers (n = 30) to determine the specific hemodynamic a nd hematologic adverse effects possibly caused by nicotine and whether the method of nicotine delivery and systemic nicotine levels achieved might influence these adverse effects. During the 5-day study, subjec ts were asked to refrain from smoking, and testing sessions were condu cted as follows: on day 1, the subjects smoked two cigarettes immediat ely before testing; on day 3 (control day), testing was done after not smoking for 48 hours and then the subjects were instructed to wear a transdermal nicotine patch (PROSTEP 22 mg/day) for 24 hours and replac e it with another so that, on day 5, testing took place after the subj ects had worn the patch for approximately 34 hours. At each testing se ssion, digital artery pulse amplitude and a number of clinical and ser um blood level parameters were measured. Relative digital blood flow a fter smoking (69.2 +/- 5.8%) and with the patch (80.4 +/- 7.6%) was lo wer than on the control day (100.0 +/- 0.0%). The nicotine patch, unli ke smoking, had no effect on vasopressin or fibrinogen concentrations, hematocrit, or white cell or platelet counts; both smoking and the pa tch resulted in elevated norepinephrine levels.