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AANA J. 2013 Aug;81(4):308-13.

AANA journal course: update for nurse anesthetists--Part3--Tobacco smoking using a waterpipe (hookah): what you need to know.

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Virginia Commonwealth University, Department of Psychology, Institute for Drug and Alcohol Studies, Richmond, USA.


Smoking tobacco using a waterpipe (hookah) is increasing worldwide and is remarkably common among adolescents and young adults in the United States. Contrary to misperceptions that waterpipe tobacco smoking presents fewer health risks than cigarette smoking, recent data demonstrate clearly that the smoke from a waterpipe contains many of the same toxicants that are in cigarettes, including the dependence-producing drug nicotine, cancer-causing polycyclic aromatic hydrocarbons, pulmonary disease-causing volatile aldehydes, and cardiovascular disease-causing carbon monoxide that can also lead to acute intoxication in waterpipe users. Because many anesthesia providers are likely treating waterpipe tobacco smokers, the goal of this AANA Journal Course is to describe a waterpipe, who uses a waterpipe to smoke tobacco, and the toxicants found in waterpipe smoke and waterpipe smokers. Based on available evidence, there is no indication that waterpipe tobacco smoking is any less risky to patient health than cigarette smoking. Anesthesia providers should begin to assess patients for this form of tobacco use explicitly and should consider addressing it as they do cigarette smoking, with the additional precaution of presurgery carboxyhemoglobin measurement.

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