Anesthesiologists sound alarm on wildfire smoke, surgical outcomes

Editor's Note

The rising frequency of wildfires has anesthesiologists concerned about potential for adverse surgical outcomes to exposed patients, according to an article in the Online First edition of Anesthesiology,  the peer-reviewed journal of the American Society of Anesthesiologists (ASA).

As of an August 6 report from ASA, nearly 100 wildfires were burning across more than 2 million acres in the US. This smoke can exacerbate heart and lung disease, impact pregnancy outcomes, and pose other significant health risks, especially for those with pre-existing conditions, obese patients, infants, young children, and other vulnerable groups.

There are significant knowledge gaps about how wildfire smoke affects anesthesia and surgery risks, ASA reports. senior author Vijay Krishnamoorthy, M.D., M.P.H., Ph. D., chief of the Critical Care Medicine Division and associate professor of anesthesiology and population health sciences at Duke University School of Medicine in Durham, North Carolina, is leading a team in the development of a mathematical model to understand these effects better. Future research could lead to guidelines for assessing and managing risks for patients exposed to wildfire smoke, such as adjusting surgery timing based on predicted smoke exposure levels to improve outcomes and reduce complications.

Wildfire smoke contains fine particles and chemicals that cause inflammation, oxidative stress, and damage to the heart, lungs, and other organs. Inhaled particles can injure blood vessel linings, activate platelets, and cause clotting abnormalities, leading to increased cardiovascular diseases and comorbidities in surgical patients. Studies also have shown that young children with asthma-like symptoms have higher risks of adverse respiratory events under anesthesia during poor air quality periods caused by wildfire smoke.