Complications of Anaesthesia ebooksclub.org Tobacco or Health Physiological and Social Damages Caused by Tobacco Smoking Second Edition

into฀the฀study฀ [204] .฀Children฀who฀have฀no฀familial฀smoking฀history฀were฀included฀in฀the฀ irst฀group฀whereas฀passive฀smokers฀included฀in฀the฀second฀group.฀Sevolurane฀in฀50฀O 2 ฀ and฀50฀N 2 O฀was฀used฀for฀induction฀of฀anaesthesia.฀Evoked฀adductor฀pollicis฀electromyo- graphy฀was฀used฀to฀monitor฀neuromuscular฀block.฀The฀T95฀and฀T25฀values฀were฀recorded.฀It฀ was฀shown฀that฀the฀T95฀values฀±SD฀for฀rocuronium฀were฀110.1฀±฀39.3฀s฀and฀79.3฀±฀35.6฀s฀for฀ group฀1฀and฀group฀2,฀respectively฀฀p฀฀0.05.฀The฀T25฀value฀of฀group฀2฀was฀40.1฀±฀10.6฀min;฀ compared฀with฀group฀1฀values฀30.85฀±฀7.02฀min,฀it฀was฀signiicantly฀longer฀฀p฀฀0.01.฀ Therefore,฀it฀can฀be฀concluded฀that฀passive฀smoking฀children฀consume฀less฀rocuronium฀ than฀non-smokers฀during฀similar฀anaesthesia.฀A฀history฀of฀passive฀smoking฀must฀also฀be฀ taken฀into฀consideration฀during฀preoperative฀evaluation฀of฀paediatric฀patients฀ [204] . Overall,฀it฀should฀be฀noted฀that: • ฀ Girls฀are฀more฀susceptible฀than฀boys฀to฀such฀complications฀ [205,฀206] ฀because฀of฀the฀ more฀favourable฀ratio฀of฀respiratory฀tract฀to฀lung฀size฀in฀boys฀ [206,฀207] . • ฀ Girls฀respond฀more฀sensitively฀than฀boys฀to฀cholinergic฀stimuli฀ [208] . • ฀ Low฀maternal฀socioeconomic฀status฀is฀associated฀with฀persistent฀lower฀respiratory฀tract฀ infections฀and฀inluences฀the฀complication฀rate฀ [209] . • ฀ According฀to฀one฀retrospective฀study,฀laryngospasm฀is฀ten฀times฀more฀common฀in฀chil- dren฀exposed฀to฀ETS฀compared฀with฀non-exposed฀children฀ [210] . • ฀ Oxygen฀desaturation฀following฀anaesthesia฀was฀observed฀more฀frequently฀in฀the฀recov- ery฀room฀in฀ETS-exposed฀children฀than฀in฀non-exposed฀children฀ [211] . • ฀ By฀using฀a฀pre-anaesthesia฀questionnaire฀or฀by฀determining฀urinary฀cotinine-levels,฀the฀ paediatric฀anaesthetist฀should฀take฀steps฀to฀prevent฀those฀complications฀of฀anaesthesia฀ that฀are฀more฀likely฀to฀occur฀in฀ETS-exposed฀children.

9.7 Otitis Media

Otitis฀media฀affects฀up฀to฀46฀of฀young฀children฀up฀to฀the฀age฀of฀3฀years฀and฀is฀the฀condi- tion฀ most฀ commonly฀ prompting฀ medical฀ consultations฀ in฀ this฀ age฀ group฀ Table฀ 9.8 ฀ [213–217] . Variable Odds฀ratio฀95฀CI฀ p฀ Number฀of฀cigarettes฀smoked฀10฀vs.฀³10 1.89฀1.22–2.91 ฀ 0.004 Child’s฀place฀of฀residence฀during฀the฀irst฀year฀of฀life฀ household฀vs.฀day฀care฀vs.฀private฀creche 2.94฀1.55–5.54 ฀ 0.001 Maternal฀educational฀level฀12฀vs.฀³13฀years 1.55฀1.05–2.30 ฀ 0.03 Doctor฀visits฀number฀during฀the฀past฀12฀months ฀ £3 1.00 ฀ 4–10 2.50฀1.70–3.67 ฀0.001 ฀ ³11 2.01฀0.96–4.18 ฀ 0.06 Table 9.8 ฀฀฀Inluence฀of฀maternal฀smoking฀on฀the฀risk฀of฀otitis฀media฀in฀young฀children.฀Calculations฀ based฀on฀a฀multivariate฀logistic฀regression฀model฀ [212] Moreover,฀ otitis฀ media฀ frequently฀ marks฀ the฀ starting฀ point฀ for฀ surgical฀ intervention฀ [74,฀213] .฀Since฀38–60฀of฀young฀children฀are฀exposed฀to฀ETS฀in฀their฀parents’฀homes,฀ passive฀smoking฀is฀an฀important฀factor฀in฀the฀development฀of฀this฀condition฀ [218–221] .฀ The฀frequency฀of฀otitis฀media,฀surgery฀and฀antimicrobial฀therapy฀during฀the฀preceding฀12฀ months฀was฀assessed฀hair฀cotinine฀measurements,฀physician฀medical฀records,฀home฀visits฀ in฀a฀study฀in฀227฀cases฀and฀398฀healthy฀controls฀who฀satisied฀the฀inclusion฀criteria฀for฀the฀ study฀Fig.฀ 9.10 ฀ [212] .฀Otitis฀media฀developed฀in฀23.9฀of฀the฀children฀and฀9.8฀had฀to฀ undergo฀ myringotomy.฀ Children฀ exposed฀ to฀ ETS฀ had฀ a฀ 2–3฀ times฀ higher฀ risk฀ of฀ otitis฀ media฀ than฀ non-exposed฀ children฀ Table฀ 9.8 .฀ These฀ results฀ are฀ consistent฀ with฀ those฀ reported฀in฀other฀studies฀ [222–225] ฀OR,฀1.80;฀CI,฀1.1–3.0฀ [222] . To฀ estimate฀ the฀ relative฀ risk฀ for฀ otitis฀ media฀ OM฀ in฀ children฀ from฀ ETS,฀ maternal฀ smoking฀ during฀ pregnancy฀ gestational฀ exposure,฀ or฀ both,฀ a฀ national฀ cross-sectional฀ health฀survey฀was฀analysed฀by฀the฀use฀of฀questionnaire฀information฀and฀serum฀cotinine฀ measurements฀ [226] .฀Children฀younger฀than฀12฀years฀N฀=฀11,728฀were฀examined฀who฀ participated฀in฀the฀Third฀National฀Health฀and฀Nutrition฀Examination฀Survey฀NHANES฀III,฀ conducted฀from฀1988฀to฀1994.฀The฀outcome฀of฀the฀study฀was฀the฀occurrence฀and฀recur- rence฀of฀ear฀infections.฀It฀was฀found฀that฀the฀cumulative฀incidence฀of฀ear฀infections฀was฀69.฀ Of฀all฀participants,฀38฀were฀exposed฀to฀passive฀smoke,฀23฀were฀exposed฀to฀gestational฀ smoke,฀and฀19฀were฀exposed฀to฀combined฀passive฀and฀gestational฀smoke.฀The฀occurrence฀ of฀any฀ear฀infection฀was฀not฀increased฀by฀passive฀smoke฀exposure฀adjusted฀risk฀ratio฀[RR],฀ 1.01;฀95฀CI,฀0.95–1.06,฀but฀was฀slightly฀increased฀by฀gestational฀adjusted฀RR,฀1.08;฀95฀ CI,฀1.01–1.14฀and฀combined฀adjusted฀RR,฀1.07;฀95฀CI,฀1.00–1.14฀smoke฀exposures.฀ The฀risk฀of฀recurrent฀ear฀infections฀³6฀lifetime฀episodes฀was฀signiicantly฀increased฀with฀ combined฀smoke฀exposure฀adjusted฀RR,฀1.44;฀95฀CI,฀1.11–1.81.฀Other฀risk฀factors฀for฀ ear฀infection฀identiied฀in฀multivariable฀analysis฀were฀raceethnicity,฀poverty–income฀ratio฀ of฀2.00฀or฀more,฀attendance฀in฀day฀care,฀history฀of฀asthma฀and฀presence฀of฀allergic฀symp- toms.฀From฀this฀study,฀it฀can฀be฀concluded฀that฀passive฀smoke฀exposure฀was฀not฀associated฀ with฀an฀increased฀risk฀of฀ever฀developing฀an฀ear฀infection.฀The฀increased฀risk฀found฀with฀ gestational฀and฀combined฀smoke฀exposures฀has฀marginal฀clinical฀signiicance.฀For฀recur- rent฀ear฀infections,฀however,฀combined฀smoke฀exposure฀had฀a฀clinically฀and฀statistically฀ signiicant฀effect฀ [226] . Continine Level [ng mg] No. of Current Household Smokers 1 0.60 0.48 0.30 n = 74 n = 13 n = 5 ≥2 0.5 1.0 1.5 2.0 Fig. 9.10 ฀฀฀Correlation฀between฀ hair฀cotinine฀concentration฀ and฀number฀of฀smokers฀in฀ household,฀according฀to฀ parental฀self-report.฀Medians฀ including฀25th฀and฀75th฀ percentiles.฀Data฀outside฀the฀ conidence฀range.฀Signiicant฀ differences฀between฀the฀ groups฀฀p฀=฀0.03฀ [212]