Children Exposed to Second-Hand Smoke at Greater Risk During Surgery

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Medical researchers have established a link between second-hand tobacco smoke and serious breathing problems for children who receive general anesthesia. Girls are at greater risk, especially those whose mothers have a lower level of education, according to a study published in the May 1998 scientific journal Anesthesiology, the scientific publication of the< href=http://www.asahq.org> American Society of Anesthesiologists (ASA). The article was accompanied by an editorial by former Surgeon General C. Everett Koop, M.D., Sc.D.

Eric T. Skolnick, M.D., assistant professor of anesthesiology and pediatrics, Columbia University College of Physicians and Surgeons, New York, and a group of researchers studied children ages one month to 12 years over a 16-month period who were scheduled to receive general anesthesia for surgery. The children's exposure to tobacco smoke was confirmed by testing their blood for the presence of the substance cotinine, the most common byproduct and indicator of nicotine exposure. The study found that the proportion of patients experiencing airway complications following general anesthesia was directly linked to the concentration of cotinine in their blood.

In the United States, almost 2 million surgical procedures are performed on children younger than 15 years old. The effects of passive smoking on children have been well- documented in the medical literature. These include decreased lung development and increased occurrences and severity of asthma, ear infections and pneumonia in infants.

According to Dr. Skolnick, "This is the first study to look at the connection between second-hand smoke and airway complications in children during surgery. Our study adds another body of scientific evidence to show that children exposed to second-hand tobacco smoke are at risk of developing life-threatening conditions during and after surgery."

Complications experienced by the children in the study included a lack of oxygen in the blood, severe coughing and airway spasms as they were being given anesthesia, when anesthesia was stopped and later in the recovery room.

Of the 499 children who tested positive for cotinine, airway complications occurred in 42 percent of the children with the highest cotinine concentrations (40 ng/ml in the urine). Based on interviews with the parents of this group, the children had been exposed to 30 cigarettes per day. This group was twice as likely to have breathing complications, the study revealed.

The next highest concentration occurred in 33 percent of the children who suffered from airway complications (continine concentrations of between 10.0 and 39.9 ng/ml). The third group, 24 percent of the patients studied, had cotinine concentrations less than 10 ng/ml. They also suffered airway complications, though less severe.

Researchers also found that the risk of airway complications is greatest for girls. "Earlier studies have shown that girls are more susceptible to the effects of second-hand smoke," Dr. Skolnick said. "This higher rate of susceptibility may be due to the fact that girls have greater lung capacity than boys prior to adolescence and therefore can breathe in more airborne irritants."

A second important factor in determining which children were at risk for respiratory complications was the mother's level of education. Girls whose mothers had less than a high school education were at greatest risk. According to Dr. Skolnick, "Our findings confirm those of earlier studies that children from low socioeconomic surroundings have a greater incidence of chronic respiratory problems. This may be due to a number of factors in the home, including crowding, stress and a lower incidence of breast-feeding."

In an accompanying editorial, former U.S. Surgeon General C. Everett Koop, M.D., Sc.D., noted, "Children who exhibit adverse respiratory events under general anesthesia -- and their mothers (families) -- are prime targets for educational programs about the dangers of ETS (environmental tobacco smoke) in childhood."

Dr. Koop also warns, "When all of the detrimental effects of ETS on children are added up, especially those in asthmatic children, smoking in households where there are children may well become the next issue in child abuse."

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Media note: The full text of the journal Anesthesiology study and accompanying editorial bv C. Everett Koop, M.D., can be found at the < href=http://www.asahq.org>ASA web site < WWW. ASAhq.org >. Eric T. Skolnick, M.D., can be reached for interviews by contacting Karin Eskenazi or Bryon Dodson, Columbia-Presbyterian Medical Center, (212) 305-5587.

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