Children exposed to secondhand tobacco, cooking smoke have high rates of pain and complications after tonsillectomy

New research presented at this year's Euroanaesthesia meeting in Stockholm shows that children exposed to indoor coal-burning stoves and/or second-hand tobacco smoke are much more likely to suffer postoperative complications and excessive pain after tonsillectomies. The research is by Professor Daniel Sessler, Cleveland Clinic, Cleveland, Ohio, USA and Dr Onur Koyuncu, Mustafa Kemal University, Hatay, Turkey, and colleagues.

Almost half of the world's population uses including biomass (wood, , and animal dung) or coal for heating and cooking. Because stoves are usually centrally positioned in homes and often the only source of heat, families tend to congregate around them and sleep nearby. Many stoves generate and release pollutants into household air including carbon monoxide. Children are also exposed to carbon monoxide via second-hand tobacco smoke, with estimates suggesting 40-70% of are exposed worldwide.

Exposure to carbon monoxide results in carboxyhaemoglobin*, which may provoke . Elevated carboxyhaemoglobin concentrations may also increase pain sensitivity. The investigators therefore tested the primary hypothesis that children with high preoperative carboxyhaemoglobin concentrations have more postoperative complications and pain after tonsillectomies. Secondarily they tested the hypothesis that high carboxyhaemoglobin concentrations are associated with more pain and painkiller use.

100 Turkish children scheduled for elective tonsillectomy were divided into low and high carbon monoxide exposure groups: carboxyhaemoglobin ≤3 or ≥4 g/dl. The primary outcome was complications during the seven days after surgery which included bronchospasm, laryngospasm, persistent coughing, desaturation (low blood oxygen), the need for re-intubation, low blood pressure, postoperative bleeding, and reoperation. Pain was evaluated with Wong-Baker Faces pain scales, and supplemental use of the painkiller tramadol was recorded for four hours postoperatively.

There were 36 patients in the low exposure group carboxyhemoglobin [mean 1.8 g/dl], and 64 patients were in the high exposure group [mean 6.4 g/dl]. Indoor coal-burning stoves were reported more often by families of the high than low carboxyhemoglobin children (89% versus 72%). Second-hand cigarette smoke exposure was reported by 54% of the families with children with high carboxyhaemoglobin, but only by 24% of the families of children with low carboxyhaemoglobin .

Complications were more common in patients with high carboxyhaemoglobin (47% versus 14% in the low group), with most occurring in the postanaesthesia care unit. Pain scores in the postanaesthesia care unit and one hour after surgery were significantly lower in the low exposure group. Similarly, tramadol use was lower in the low-exposure group at both 4 hours (3.5 vs. 6.0 mg) and 24 hours (3.5 vs. 6.0 mg).

The authors conclude: "Children exposed to substantial environmental have more complications and more after general anaesthesia than less exposed children."

add to favorites email to friend print save as pdf

Related Stories

Patients report high satisfaction with pain treatment

Apr 28, 2014

An international research group with members from the University of Basel, several EU countries, Israel and the USA, analyzed patient satisfaction with pain treatment after surgery. The study based on an extensive multi-national ...

Pre-op pregabalin best for pain in spinal surgery

Mar 28, 2014

(HealthDay)—Preoperative pregabalin is superior to either gabapentin or placebo for the relief of pain in patients undergoing lumbar discectomy, according to a study published in the March 15 issue of Spine.

Recommended for you

Independent safety investigation needed in the NHS

39 minutes ago

The NHS should follow the lead of aviation and other safety-critical industries and establish an independent safety investigation agency, according to a paper published today by the Journal of the Royal Society of Medicine. The au ...

Sexual fantasies: Are you normal?

4 hours ago

Hoping for sex with two women is common but fantasizing about golden showers is not. That's just one of the findings from a research project that scientifically defines sexual deviation for the first time ever. It was undertaken ...

AMA 'Code of Ethics' offers guidance for physicians

10 hours ago

(HealthDay)—The American Medical Association (AMA) Code of Ethics and other articles provide guidance for physicians in relation to public health emergencies, according to a report from the AMA.

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.