The Malaysian Society of Anaesthesiologists and College of Anaesthesiologists, Academy of Medicine of Malaysia would like to applaud the steps taken by Health Minister, YB Khairy Jamaluddin, who tabled the Control of Tobacco Products and Smoking Bill 2022 for the first reading in Parliament on 27th July 2022 and has scheduled to table the Bill for the second reading in the Dewan Rakyat on the 1st August 2022, with the debate session and winding up for the Bill to be held on the 2nd August 2022.
The Bill aims to prohibit those born after 1st January 2007 from purchasing or possessing cigarettes or vape products, with a fine not exceeding RM5,000 given to those who are caught buying, smoking, or possessing smoking-related products. Despite the criticism from some quarters with regards to the tabling of the Bill and its impact to the tobacco industry as well as negative feedback from some consumers, it is without a doubt that the Bill will see a lot of positive outcomes that may not be immediate but will be apparent in the years to come.
As anaesthesiologists and critical care physicians, we are at the forefront of seeing patients presenting to us with various disease such as chronic lung diseases, lung cancers, cardiovascular diseases and peripheral vascular diseases that can be attributed to the dangers of smoking, especially due to the nicotine and other harmful content in the tobacco products.
Many have mistakenly concluded that E-cigarettes and vaping is less harmful than smoking. The United States Surgeon General’s Advisory on E-cigarette Use Among Youth has showed that E-cigarette is not harmless as most e-cigarettes contain nicotine which is the addictive drug in regular cigarettes, cigars, and other tobacco products. Nicotine exposure during adolescence can also harm the developing brain (said to be continuing to develop until about the age of 25). Nicotine exposure during adolescence is also associated with impairment of learning, memory, and attention. Using nicotine in adolescence can also increase risk for future addiction to other drugs.
In addition to nicotine, the aerosol that users inhale and exhale from e-cigarettes can potentially expose both themselves and bystanders to other harmful substances, including heavy metals, volatile organic compounds, and ultrafine particles that can be inhaled deeply into the lungs
For an anaesthesiologist preparing a patient for surgery, one of the key determining factors on whether a patient will have an uneventful recovery after anaesthesia is the history of smoking. Smokers have increased risks of respiratory, cardiovascular and wound healing complications in the perioperative period compared to non-smokers. A 2011 study of patients undergoing non-cardiac surgery showed that current smoking (had smoked within the last year compared with never smoked) was associated with 40% increased odds of 30-day mortality and 30 to 100% increased odds of major morbidity including surgical-site infection, pneumonia, myocardial infarction and septic shock.
Although data is still being collected on the exact harmful effects of E-cigarette and vaping have on patients undergoing anaesthesia, we strongly advocate prevention is better than cure. Many of the known cardiovascular especially the unpredictable hemodynamic effects as result of nicotine induced catecholamine release and respiratory effects of nicotine such as airway hyperreactivity, increased secretions, bronchospasm and laryngospasm will be similar irrespective of the method of smoking whether it is the traditional cigarette sticks or the modern versions.
The Malaysian Society of Anaesthesiologists and College of Anaesthesiologists, Academy of Medicine of Malaysia would strongly support the successful tabling and passing of the Control of Tobacco Products and Smoking Bill 2022 that will continue to reduce the burden of managing diseases that are directly attributed to the harmful effects of smoking of tobacco and other associated products.