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The impact of passive smoking on perioperative outcomes among infants and children undergoing ambulatory surgery: a prospective observational study
Position du problème et objectif(s) de l’étude
Passive smoking among infants and children is still frequent in low-resource countries and may lead to several paediatric comorbidities. The aim of this study is to assess its impact on anaesthetic and surgical outcomes.
Matériel et méthodes
In this prospective observational study, we included all children aged 6 months to 6 years, having ASA I-II classes, and undergoing ambulatory ilio-inguinal surgery. Patients were divided into two groups according to their environmental tobacco exposure (exposed children versus non-exposed). The anaesthesia protocol and surgical procedures were standardised for all patients. Then, we compared the outcomes of the two groups of children. The significance level was set at p<0.05, and the relative risk was given with a 95% confidence interval.
Résultats & Discussion
Demographic parameters were comparable in both groups. The passive smoking increased the risk of preoperative anxiety (RR=1.857; 95%CI: 1.02- 3.37). The incidence of perioperative respiratory adverse events was significantly increased from 14.8% among non-exposed children to 29.2% among the exposed (p=0.003; RR= 2,368; 95%CI: 1,28 – 3.28). Passive smoking increased the incidence of delayed awakening from 19.4% to 38% (p=0.0027; RR=1.76; 95%CI: 1.04-5.34), and emergence delirium from 43.5% to 56.2% (p=0.023; RR=1.669; 95%CI: 1.037-2,684). Higher risks for hospital admission (RR=2,91; 95%CI: 1,40-6.06), and delayed wound healing (RR=3.65; 95%CI: 1,48 – 9,23) were correlated with the tobacco smoke exposure.
Conclusion
Our study emphasises the risks of passive smoking to children undergoing ambulatory surgery. It seems that exposed children may require specific anaesthetic management for preoperative anxiety, perioperative respiratory adverse events, and delirium emergence. Surgical precautions are also required to prevent the consequences of wound healing.
Auteurs
Manel KAMMOUN, Hend KETATA, Amina KALLEL, Mariem KHROUF, Abir MISSEOUI, Omar TERKAOUCHI, Kais MAATALLAH, Anouar JARRAYA - (1)Chu Hedi Chaker De Sfax, Sfax, Tunisie