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R E S E A R C HR E P O R T S

A Parent’s Smoke Increases Child’s Surgery Risk

Lead Researcher: Eric Skolnick

Children who are exposed to secondhand smoke from parents are more likely to have breathing-related complications after routine childhood surgery than children who live in a smoke-free environment, concludes a study conducted by Dr. Eric Skolnick, assistant professor of anesthesiology and of pediatrics at P&S.

Tobacco smoke is an airway irritant not only for those who smoke but for those who breathe in the polluted air that smokers create. The effects are especially dramatic in children. Environmental tobacco smoke can, among other things, slow a child’s lung growth, reduce lung volume, increase the number and severity of asthma attacks, make a child more vulnerable to colds, and impair the airway’s ability to expel mucus. These changes appear to set the stage for more serious problems when a child undergoes surgery that involves general anesthesia, which also enters via the lungs. Each year, nearly 2 million children under age 15 undergo ear tube insertions, hernia operations, tonsillectomies, and other operations that require general anesthesia.

The possible consequences range from the “mere” discomfort of severe coughing to life-threatening laryngospasm or bronchospasm, says Dr. Skolnick. The cost of treating asthma attacks is also an issue. “These children may need extra time in the operating room, may have to go to the intensive care unit or a monitored bed, or may have to stay in the hospital longer instead of going home,” he says.

Dr. Skolnick and his team measured cotinine, a breakdown product of nicotine considered to be a reliable measure of a child’s exposure to cigarette smoke, in the urine of 499 children, ages 1 month to 12 years, who were scheduled for surgery. During and after the surgery, the researchers kept track of respiratory complications, among them laryngospasm and bronchospasm—the vocal cords or airways squeeze shut, making it very difficult for the young patient to breathe—wheezing, breath holding, severe coughing, and excess mucus production.

The results show that the greater a child’s exposure to smoke before surgery, the more likely the child will have a respiratory problem during or after surgery.

“What we ultimately envision is meeting with a child’s parents before surgery, finding out if they smoke, and, if so, telling them we now know smoking is related to a higher rate of complications during and after surgery,” says Dr. Skolnick. “We would then offer to help them stop smoking.” To bring the point home, Dr. Skolnick suggests measuring the cotinine in the child’s urine the day of the consultation. “Most parents wouldn’t dream of feeding their baby nicotine, but by smoking in the child’s presence that’s exactly what they’re doing. Parents may not care so much about themselves, but they may be willing to quit smoking for their child.” A follow-up urine test for the child could prove that the parents’ sacrifice has been worthwhile.

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