BMJ 2014;348:g1961 doi: 10.1136/bmj.g1961 (Published 10 March 2014)
Page 1 of 1
Letters
LETTERS DETRIMENTAL EFFECTS OF E-CIGARETTES
It is preferable for surgical patients to use e-cigarettes rather than smoke cigarettes Konstantinos Farsalinos cardiologist-researcher, Vassilis Voudris cardiologist and director Onassis Cardiac Surgery Centre, Kallithea 17674, Greece
The title of Holmes and Southern’s letter led us to expect descriptions of case reports on the detrimental effects of e-cigarettes and an attempt to associate such effects with the use of e-cigarettes.1 Instead, the letter just mentions the theoretical adverse effects of e-cigarettes on surgical outcomes and is not backed by any kind of evidence.
The authors seem to confuse the effects of nicotine and smoking. Some of the studies they cite make it clear that nicotine has minimal, if any, adverse effects on wound healing compared with those of smoking.2 3 One study noted raised tissue oxygen tension after nicotine infusion, in contrast to the reduction seen after smoking.2 Another study by the same group found that smoking cessation improved wound healing irrespective of whether a nicotine or placebo patch was used as a smoking cessation aid.3 With regard to e-cigarettes, the vapour from 20 e-cigarettes was shown to have minimal cytotoxic effects on skin fibroblasts.4 The incidence of smoking is about 30% in general surgical populations undergoing elective procedures.5 Obviously, clinical studies need to be performed to determine the effects of e-cigarette use on surgical outcomes. However, currently available evidence suggests that it would be preferable for smokers to use e-cigarettes rather than smoke during the
preoperative period.6 In any case, the title of Holmes and Southern’s letter is misleading when you consider the letter’s contents. Competing interests: The authors have performed studies on e-cigarettes, for some of which the institution had received unrestricted funding from e-cigarette companies. 1 2 3 4
5 6
Holmes WJM, Southern SJ. Detrimental effects of e-cigarettes on surgical outcomes. BMJ 2014;348:g1156. (5 February.) Sørensen LT, Jørgensen S, Petersen LJ, Hemmingsen U, Bülow J, Loft S, et al. Acute effects of nicotine and smoking on blood flow, tissue oxygen, and aerobe metabolism of the skin and subcutis. J Surg Res 2009;152:224-30. Sørensen LT, Toft BG, Rygaard J, Ladelund S, Paddon M, James T, et al. Effect of smoking, smoking cessation, and nicotine patch on wound dimension, vitamin C, and systemic markers of collagen metabolism. Surgery 2010;148:982-90. Romagna G, Allifranchini E, Bocchietto E, Todeschi S, Esposito M, Farsalinos KE. Cytotoxicity evaluation of electronic cigarette vapor extract on cultured mammalian fibroblasts (ClearStream-LIFE): comparison with tobacco cigarette smoke extract. Inhal Toxicol 2013;25:354-61. Tønnesen H, Nielsen PR, Lauritzen JB, Møller AM. Smoking and alcohol intervention before surgery: evidence for best practice. Br J Anaesth 2009;102:297-306. Farsalinos KE, Polosa R. Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarettes substitutes: a systematic review. Ther Adv Drug Safe 2014; published online 13 Feb.
Cite this as: BMJ 2014;348:g1961 © BMJ Publishing Group Ltd 2014
[email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
Page 1 of 1
Letters
LETTERS DETRIMENTAL EFFECTS OF E-CIGARETTES
It is preferable for surgical patients to use e-cigarettes rather than smoke cigarettes Konstantinos Farsalinos cardiologist-researcher, Vassilis Voudris cardiologist and director Onassis Cardiac Surgery Centre, Kallithea 17674, Greece
The title of Holmes and Southern’s letter led us to expect descriptions of case reports on the detrimental effects of e-cigarettes and an attempt to associate such effects with the use of e-cigarettes.1 Instead, the letter just mentions the theoretical adverse effects of e-cigarettes on surgical outcomes and is not backed by any kind of evidence.
The authors seem to confuse the effects of nicotine and smoking. Some of the studies they cite make it clear that nicotine has minimal, if any, adverse effects on wound healing compared with those of smoking.2 3 One study noted raised tissue oxygen tension after nicotine infusion, in contrast to the reduction seen after smoking.2 Another study by the same group found that smoking cessation improved wound healing irrespective of whether a nicotine or placebo patch was used as a smoking cessation aid.3 With regard to e-cigarettes, the vapour from 20 e-cigarettes was shown to have minimal cytotoxic effects on skin fibroblasts.4 The incidence of smoking is about 30% in general surgical populations undergoing elective procedures.5 Obviously, clinical studies need to be performed to determine the effects of e-cigarette use on surgical outcomes. However, currently available evidence suggests that it would be preferable for smokers to use e-cigarettes rather than smoke during the
preoperative period.6 In any case, the title of Holmes and Southern’s letter is misleading when you consider the letter’s contents. Competing interests: The authors have performed studies on e-cigarettes, for some of which the institution had received unrestricted funding from e-cigarette companies. 1 2 3 4
5 6
Holmes WJM, Southern SJ. Detrimental effects of e-cigarettes on surgical outcomes. BMJ 2014;348:g1156. (5 February.) Sørensen LT, Jørgensen S, Petersen LJ, Hemmingsen U, Bülow J, Loft S, et al. Acute effects of nicotine and smoking on blood flow, tissue oxygen, and aerobe metabolism of the skin and subcutis. J Surg Res 2009;152:224-30. Sørensen LT, Toft BG, Rygaard J, Ladelund S, Paddon M, James T, et al. Effect of smoking, smoking cessation, and nicotine patch on wound dimension, vitamin C, and systemic markers of collagen metabolism. Surgery 2010;148:982-90. Romagna G, Allifranchini E, Bocchietto E, Todeschi S, Esposito M, Farsalinos KE. Cytotoxicity evaluation of electronic cigarette vapor extract on cultured mammalian fibroblasts (ClearStream-LIFE): comparison with tobacco cigarette smoke extract. Inhal Toxicol 2013;25:354-61. Tønnesen H, Nielsen PR, Lauritzen JB, Møller AM. Smoking and alcohol intervention before surgery: evidence for best practice. Br J Anaesth 2009;102:297-306. Farsalinos KE, Polosa R. Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarettes substitutes: a systematic review. Ther Adv Drug Safe 2014; published online 13 Feb.
Cite this as: BMJ 2014;348:g1961 © BMJ Publishing Group Ltd 2014
[email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
