BACKGROUND: To test whether smokers have exaggerated hemodynamic responses to induction and intubation, we investigated the changes in blood pressure (BP) and heart rate (HR) on induction and intubation in smokers and nonsmokers.

METHODS: Healthy male patients (25 smokers and 25 nonsmokers, aged 20 to 29 yrs) for elective surgery were studied. Anesthesia was induced with thiopental 3 mg/kg, fentanyl 1.5 µg/kg, vecuronium 0.1 mg/kg and maintained with enflurane 1 % in N₂O and O₂ for the period of observation. After three minutes, orotracheal intubation was performed. Noninvasive BP and HR were recorded one minute before induction (baseline), immediately before intubation, and then every minute until five minutes after intubation.

RESULTS: Systolic BP of smokers decreased significantly immediately before intubation, and at 4 and 5 min after intubation as compared to that of nonsmokers (Mean ± SEM, 120.8 ± 3.0 vs. 109.9 ± 2.8, 116.7 ± 2.4 vs. 108.9 ± 2.3, and 114.8 ± 2.2 vs. 106.7 ± 2.3 mmHg, respectively, P < 0.05). Diastolic BP of smokers decreased only immediately before intubation compared with that of nonsmokers (Mean ± SEM, nonsmoker 64.6 ± 2.4 vs. smoker 58.6 ± 1.8 mmHg, P < 0.05). However, there was no significant difference of HR between smokers and nonsmokers during the observational period.

CONCLUSIONS: Hemodynamic response is different in smokers compared with nonsmokers. Our results indicate that smoking affects the hemodynamic response to induction and intubation.