Consider postponing surgery during wildfire episodes

If it seems like a growing global crisis, that’s because it is. Over the last 20 years, around 60% of countries in the world have witnessed an increase in wildfires and the concomitant problem caused by smoke.

On the day that the American Society of Anesthesiologists issued a report highlighting the impact of wildfire smoke on patients under anesthesia, around 100 wildfires were raging throughout the USA, consuming over 2 million acres.

The new report discusses the possibility that some patients exposed to wildfire might be more susceptible to suffering adverse outcomes from anesthesia and surgery as a result.

It is impossible to determine the exact chemical make-up of wildfire smoke but it invariably contains a complex mix of fine particles and chemicals which, once inhaled, can damage the lining of blood vessels and cause clotting abnormalities in small blood vessels. 

The new article builds on previous research, that found that under general anesthesia, young children with a history of reactive airway disease – such as asthma – had a greater chance of suffering of adverse respiratory events during wildfire episodes.

Amongst that already vulnerable group, the risk of adverse respiratory events increased from 36.8% during healthy air periods to 55.1% during periods with unhealthy air.

Vijay Krishnamoorthy, 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 said: ‘Wildfire smoke causes inflammation and is known to worsen heart and lung disease and pregnancy outcomes. At a time of rising global exposure, anesthesiologists need to be equipped to manage the potential adverse effects of wildfire smoke exposure on perioperative outcomes.’

The paper observes that current weather forecasting now allows for accurate smoke plume spread prediction, which triggers air pollution warning systems and suggests that changes could be made in the scheduling of surgical cases in high-risk patients during these periods. 

Dr. Krishnamoorthy said: ‘Wildfire smoke poses significant health risks, particularly in people with pre-existing heart and lung disease, obese patients, infants and young children, and other vulnerable groups. We hope our paper will inform anesthesia clinicians about the potential impact of wildfire smoke on patient outcomes, and the urgent need for information and action to better understand and manage these risks.’

Read the full paper here.