Nicotine use has several physiologic implications that could potentially impact a patient’s intraoperative course under anesthesia. Nicotine is a potent parasympathomimetic alkaloid that functions as a nicotinic acetylcholine receptor agonist. Through stimulation of the sympathetic nervous system, blood pressure, heart rate, and pulmonary vascular resistance are increased. Aortic and carotid body receptors are essentially “reset” to maintain a higher baseline blood pressure. In addition, there is increased myocardial contractility, thus increasing both oxygen demand and consumption. Finally, through sympathetic stimulation and acetylcholine, carotid body activity and thus minute ventilation are increased. Despite these effects, epidemiologic studies have not shown that nicotine is in itself a significant cause of cardiovascular disease.
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