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Early venous catheter blockade: a cause for immediate concern
Author(s) -
Bhanumurthy S.,
McMurray T.J.,
Ban C.
Publication year - 1995
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/j.1365-2044.1995.tb06018.x
Subject(s) - medicine , citation , library science , computer science
Current literature [l, 21 suggests cessation of smoking should be encouraged in all patients prior to surgery as this reduces postoperative pulmonary morbidity. A previously fit 72-year-old man presented for elective repair of an abdominal aortic aneurysm. He was not receiving any medication and he admitted to smoking 20 cigarettes per day. After an uneventful procedure he was returned to the Intensive Care Unit breathing spontaneously, with an epidural in situ for pain relief. His recovery was uneventful for 36 h, after which he became acutely confused, agitated and aggressive and appeared to be suffering from visual hallucinations. Although physical examination was impossible, haematological, biochemical and arterial blood gas investigations were normal. A diagnosis of acute nicotine withdrawal was considered although an infective, cardiac or central nervous system cause could not be excluded at this time. The patient was sedated with daizemuls and he remained haemodynamically stable. A subsequent interview with the patient’s wife revealed that he smoked 60 cigarettes per day and so it was decided to purchase a box of nictone replacement patches from a local chemist. A 15 mgpatch was placed on the patient whilst he was still sedated. Allowing a few hours for this to have an effect, the patient was allowed to wake up, after which he was cooperative and orientated in person and place and had no recollection of the previous 8 h. Physical examination, a chest X ray, electrocardiogram and urine analysis were normal. He remained well with the continuation of his nicotine patches and was discharged to a surgical ward where he was allowed to smoke. This man’s acute confusional state was most likely caused by the abrupt withdrawal of nicotine since his symptoms disappeared with nicotine replacement. Our experience poses a question; is admission to hospital for surgery an appropriate time to encourage abstinence from smoking or are we merely substituting one set of problems for another?