I agree with Drs. Feinstein and Katz that little is known about perioperative vaping. The authors refer to an outbreak of 53 cases of e-cigarette and vaping–related lung injury, in which 84% of the cases admitted to the use of tetrahydrocannabinol products. The remaining 16% may have concealed the use of an illegal product, or not known what they were using. In those cases of e-cigarette and vaping–related lung injury where bronchoalveolar lavage was performed, 100% of the specimens were positive for vitamin E acetate, a dangerous contaminant in tetrahydrocannabinol oil. This outbreak is troubling but it is unrelated to the use of legal nicotine-based vaping products.

They also refer to a letter that raises the hypothetical possibility that an anxious preoperative patient might vape “lavishly” to the point of nicotine intoxication, which could destabilize...

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