It's well known that when a family member smokes, children are a vulnerable and
captive audience. Now, researchers document another problem: A greater risk for respiratory complications during outpatient surgical procedures.
Dwight Jones, MD, in Children's Hospital Boston's Division of Otolaryngology, and Brigham and Women's colleague Neil Bhattacharyya, MD, followed 405 patients, 168 of whom were from households with smokers. The children's procedures ranged from
drainage of middle-ear fluid to circumcision to hernia repair. All received general
anesthesia and face-mask ventilation.
The researchers found that children living with smokers had significantly more airway
complications in the operating room: excessive mucus secretion (38 vs. 8 percent),
breath-holding (15 vs. 6 percent), laryngospasm or bronchospasm (29 vs. 5 percent) and airway obstruction (29 vs. 11 percent). The more cigarettes smoked at the child's home, the more severe the complications. Some children needed bronchodilators and extra oxygen, and some needed to be admitted overnight.
Complications also increased in the recovery room. "We had a harder time waking children up in the recovery room because of choking, gagging and secretions," says Dr. Jones.
The findings, published in the July 1 issue of
Otolaryngology-Head and Neck Surgery, suggest that children who live with smokers may need more attention to their airways when undergoing surgery. Instead of face-mask ventilation, used in most minor procedures, an
endotracheal tube may be required, Dr. Jones says. Parents should be asked
about smoking in the home and advised that their child might need to be admitted should respiratory problems arise.
