To the Editor:
I agree with Drs. Feinstein and Katz that little is known about perioperative vaping.1 The authors refer to an outbreak of 53 cases of e-cigarette and vaping–related lung injury, in which 84% of the cases admitted to the use of tetrahydrocannabinol products. The remaining 16% may have concealed the use of an illegal product, or not known what they were using. In those cases of e-cigarette and vaping–related lung injury where bronchoalveolar lavage was performed, 100% of the specimens were positive for vitamin E acetate, a dangerous contaminant in tetrahydrocannabinol oil.2 This outbreak is troubling but it is unrelated to the use of legal nicotine-based vaping products.
They also refer to a letter that raises the hypothetical possibility that an anxious preoperative patient might vape “lavishly” to the point of nicotine intoxication, which could destabilize the cardiovascular system.3 However, they do not report any such cases.
Vaping does not involve inhaling smoke, and it is tobacco-free. (Vaping supplies are legally categorized as “tobacco products” only because they may contain nicotine, usually derived from tobacco.) Public Health England estimates that the risk from vaping is unlikely to be more than 5% of the risk of smoking.4 In assessing the perioperative risks of vaping, anesthesiologists should be aware that vape may contain no nicotine, or it may contain an amount that produces similar blood nicotine levels to cigarette smoke. Vape does not contain carbon monoxide, and the levels of other toxins are 82 to 99% lower than in tobacco smoke.5
Preoperatively, anesthesiologists should ask patients about smoking, vaping, and the use of cannabis and illegal drugs. Current vapers may have quit smoking but still suffer residual ill health due to their previous tobacco use. There is evidence that smokers benefit from switching to nicotine replacement therapy 6 to 8 weeks before surgery. Vaping can be considered a form of nicotine replacement therapy and therefore may be beneficial for smokers undergoing surgery. Patients who are addicted to nicotine, either from smoking or from vaping, should be offered nicotine replacement therapy while they are confined to a “No Smoking/No Vaping” area such as a hospital.
E-cigarettes were patented in 2004, and there are now 42 million vapers globally, but I have been unable to find any reports of anesthesia complications due to vaping. Research is needed so that we can base our discussion of the risks of perioperative vaping on real data rather than supposition.
The author declares no competing interests.