• Yuko Shimizu, Yasuko Baba, Yusuke Nagamine, and Kiyoyasu Kurahashi.
• Department of Anesthesiology, Yokohama City University Medical Center, Yokohama 232-0024.
• Masui. 2013 Nov 1;62(11):1372-4.

BackgroundPerioperative complications are prevalent among current smokers. Smoking cessation program is covered by national insurance for patients who meet certain criteria in Japan. We established a smoking cessation program in a preoperative clinic of our anesthesia department in July 2010.MethodsWe pick up patients who meet the following criteria; Brinkman index of over 200, tobacco dependence screener test of 5 or higher, and having a will to quit smoking, and encourage them to enroll in the program. The program consists of counseling, prescription of varenicline, and an examination of carbon monoxide fraction in exhaled breath. Patients who lose impulse to smoke and actually quit smoking when 12 weeks' program is completed are considered as successes.ResultsAs of December 2012, 24 patients were enrolled in the program. Eighteen succeeded, 2 failed, and 4 discontinued the program. The discontinuers of the program were patients who had side effects (2) and patients who lost will to quit smoking (2). The success rate was 75%.DiscussionVarenicline is one of the first-line medications for smoking cessation aid in the U.S.A. and is also approved in Japan. It is also well documented that counseling in addition to medication results in higher smoking abstinence rate than either counseling or medication alone. Anesthesiologists usually have better knowledge about perioperative complications related to smoking than physicians of other specialties. Therefore, there is an advantage in anesthesiologists being the counselor of the smoking cessation program. In addition, patients may be well motivated for quitting smoking right before receiving a surgery.ConclusionsSmoking cessation program is effective when offered to patients right before surgery. Preoperative anesthesia clinic may be one of the most suitable opportunities for the program.

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