2nd Department of Internal Medicine (Cardiology) and Anesthesiology, Gifu University Graduate School of Medicine, Gifu, Japan.
J Anesth. 2012 Dec;26(6):928-31. doi: 10.1007/s00540-012-1433-3. Epub 2012 Jun 29.
Preoperative smoking cessation is important for recovery from surgery without complications. Available evidence suggests nicotine replacement therapy could be safe and effective in the perioperative period. On the other hand, the newly developed selective nicotinic acetylcholine (ACh) receptor partial agonist, varenicline tartrate, is also effective as an aid for smoking cessation and helps people to stop smoking. During the transitional phase between the decision to stop smoking and actual smoking cessation, patients could use varenicline before undertaking smoking cessation. We have previously reported that acute cigarette smoking can cause impairment of endothelium-dependent vasodilation in cerebral vessels; thus, the use of varenicline before surgery in a patient who is still a smoker may not be safe with regard to endothelial function. Therefore, to assess the safety of varenicline in terms of endothelial function, we evaluated its effect on the acute smoking-induced impairment of endothelium-dependent cerebral vasodilation. In anesthetized Sprague-Dawley rats, we applied ACh topically to pial vessels; then, after administering intravenous varenicline or saline injection, we reexamined the ACh-induced vasodilator response both before and after smoking. Under control conditions, cerebral pial arterioles were dose-relatedly dilated by ACh. After smoking, 10(-5) M ACh constricted the arterioles following saline pretreatment (diameter -7.6 ± 1.8 %, n = 6), but induced dilation following varenicline pretreatment (diameter +15.3 ± 3.3 %, n = 6). Thus, varenicline may prevent the smoking-induced impairment of endothelium-dependent vasodilation in cerebral pial arterioles.
术前戒烟对于避免手术并发症后康复很重要。现有证据表明，尼古丁替代疗法在围手术期可能是安全有效的。另一方面，新开发的选择性烟碱型乙酰胆碱（ACh）受体部分激动剂酒石酸伐尼克兰也被证明是戒烟的有效辅助手段，可以帮助人们戒烟。在决定戒烟到实际戒烟的过渡阶段，患者可以在开始戒烟前使用伐尼克兰。我们之前曾报道过，急性吸烟会导致脑血管内皮依赖性舒张功能受损；因此，对于仍在吸烟的手术患者，术前使用伐尼克兰可能会对内皮功能产生不良影响。因此，为了评估伐尼克兰在内皮功能方面的安全性，我们评估了它对急性吸烟引起的内皮依赖性脑血管舒张受损的影响。在麻醉的 Sprague-Dawley 大鼠中，我们将 ACh 局部应用于软脑膜血管；然后，在静脉注射伐尼克兰或生理盐水后，我们在吸烟前后重新检查 ACh 诱导的血管舒张反应。在对照条件下，ACh 使软脑膜小动脉呈剂量依赖性扩张。吸烟后，10(-5) M ACh 在生理盐水预处理后使小动脉收缩（直径-7.6 ± 1.8%，n = 6），但在伐尼克兰预处理后诱导扩张（直径+15.3 ± 3.3%，n = 6）。因此，伐尼克兰可能预防吸烟引起的软脑膜小动脉内皮依赖性舒张受损。
