Exposure to environmental tobacco smoke and the risk of adverse respiratory events in children receiving general anesthesia.
BACKGROUND
Exposure to environmental tobacco smoke is associated with detrimental effects on pulmonary function in children. The authors investigated the relation between airway complications in children receiving general anesthesia and the passive inhalation of tobacco smoke.


METHODS
Six hundred two children scheduled to receive general anesthesia were enrolled in this prospective study. The anesthesiologist and the recovery room nurse, unaware of the smoke exposure history, recorded the occurrence of airway complications. A history of passive smoking was assessed by measuring the urinary concentration of the major nicotine metabolite cotinine and by questionnaire.


RESULTS
Airway complications occurred in 42% of the patients with urinary concentrations of cotinine > or =40 ng/ml, in 33% of the patients with concentrations of cotinine between 10.0 and 39.9 ng/ml, and in 24% of the patients with concentrations of cotinine < 10 ng/ml (P = 0.01 for the trend among the three groups). The gender of the child (P = 0.001) and the educational level of the child's mother (P = 0.0008) significantly modified the effect of the concentration of cotinine on the incidence of adverse respiratory events.


CONCLUSIONS
There is a strong association between passive inhalation of tobacco smoke and airway complications in children receiving general anesthesia. The relationship is greatest for girls and for those whose mothers have a lower level of education. Passive smoking should be regarded as a risk factor in children undergoing general anesthesia.
Skolnick
E T
ET
Department of Anesthesiology, Columbia University College of Physicians and Surgeons and The Babies and Children's Hospital of New York, New York, USA. ETS1@Columbia.edu
Vomvolakis
M A
MA
Buck
K A
KA
Mannino
S F
SF
Sun
L S
LS
D000768:Anesthesia, General; D002648:Child; D002675:Child, Preschool; D003367:Cotinine / Q000652:urine; D004522:Educational Status; D005260:Female; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000209:etiology*; D008297:Male; D011446:Prospective Studies; D012140:Respiratory Tract Diseases / Q000209:etiology*; D012737:Sex Factors; D011795:Surveys and Questionnaires; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*
D014028:Tobacco Smoke Pollution; D003367:Cotinine