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Smokers have an elevated risk of perioperative respiratory distress and of transfer to intensive care. Tobacco smoke substantially alters the healing process and constitutes a documented risk factor for postoperative complications (anastomotic leakage, delayed healing etc.). Risk of postoperative infection is also higher in smokers. When patients stop smoking 6 to 8 weeks before surgery, the incidence of complications related to tobacco smoke drops nearly to zero. Even stopping for a short period reduces the risk of complications, although the benefits of stopping increase with length of time. Preoperative smoking cessation should take place as early as possible. The general practitioner and the surgeon both have essential roles to play. Identification of smokers must be accompanied by measures to help the patient stop smoking, including advice, and if necessary, nicotine substitutes. Anxiety levels are higher in smokers than nonsmokers. Nonetheless smoking cessation for hospitalization does not increase these levels, even without nicotine substitutes. There is no interaction between anesthetic agents and nicotine substitutes: the latter may be continued through the morning of surgery and reinitiated in the immediate postoperative period. Patients who stop smoking for surgery should be encouraged to continue to stop, permanently. The general practitioner's support is essential for this.

THE SURVIVAL CHAIN: The delay to restoration of spontaneous circulation is the key to prognosis of cardiac arrest occurring outside the hospital. Among the many etiologies of cardiac arrest, sudden onset ventricular fibrillation is the number one cause of sudden death in adults. Better prognosis depends on effective organisation founded on the concept of a "survival chain". ALERT AND RESUSCITATION: By alerting the emergency units and performing the basic gestures of cardiopulmonary resuscitation (freeing the airways, mouth-to-mouth ventilation and closed chest cardiac massage) those witnessing the event take the first steps in the survival chain while waiting for the paramedical and medical teams to arrive. DEFIBRILLATION: In case of ventricular fibrillation, prognosis is directly related to the delay to defibrillation. Defibrillators used by specially trained paramedics before a physician arrives on the scene have considerably improved prognosis. SPECIALIZED RESUSCITATION: Precise algorithms help guide treatment in accordance with the observed cardiac rhythm. Tracheal intubation and artificial ventilation are fundamental. Among the useful drugs, epinephrine is by far the most important for improving myocardial and cerebral perfusion, improving the chances of recovering spontaneous circulation. The only anti-arrhythmic drug currently used is lidocaine. Infusion of alkaline fluid is only useful in specific cases of prolonged resuscitation. Expired CO2 monitoring may be a useful guide, but discontinuing resuscitation is strictly a medical decision. AFTER RESUSCITATION: When spontaneous circulation has been achieved, the patient must be transported to a cardiac hospital for specialized care and etiological treatment.