The waterpipe is an ancient Middle Eastern tobacco delivery system, which is also known as hookah, shisha, or narghile, and it is gaining widespread use. Waterpipes are often perceived as less dangerous than cigarettes. The amount of smoke inhaled in a waterpipe session may equal that produced by more than 100 cigarettes with high nicotine, carbon monoxide, and carcinogen intake. A case of significantly elevated intraoperative carboxyhemoglobin level and decreased oxyhemoglobin saturation in a patient with recent waterpipe use is presented.
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