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Jarraya A, Kammoun M, Ammar S, Feki W, Kolsi K. Predictors of perioperative respiratory adverse events among children with upper respiratory tract infection undergoing pediatric ambulatory ilioinguinal surgery: a prospective observational research. WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000524. [PMID: 36969907 PMCID: PMC10032407 DOI: 10.1136/wjps-2022-000524] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/27/2023] [Indexed: 03/24/2023] Open
Abstract
Objectives Anesthesia for children with an upper respiratory tract infection (URI) has an increased risk of perioperative respiratory adverse events (PRAEs) that may be predicted according to the COLDS score. The aims of this study were to evaluate the validity of the COLDS score in children undergoing ilioinguinal ambulatory surgery with mild to moderate URI and to investigate new predictors of PRAEs. Methods This was a prospective observational study including children aged 1–5 years with mild to moderate symptoms of URI who were proposed for ambulatory ilioinguinal surgery. The anesthesia protocol was standardized. Patients were divided into two groups according to the incidence of PRAEs. Multivariate logistic regression was performed to assess predictors for PRAEs. Results In this observational study, 216 children were included. The incidence of PRAEs was 21%. Predictors of PRAEs were respiratory comorbidities (adjusted OR (aOR)=6.3, 95% CI 1.19 to 33.2; p=0.003), patients postponed before 15 days (aOR=4.3, 95% CI 0.83 to 22.4; p=0.029), passive smoking (aOR=5.31, 95% CI 2.07 to 13.6; p=0.001), and COLDS score of >10 (aOR=3.7, 95% CI 0.2 to 53.4; p=0.036). Conclusions Even in ambulatory surgery, the COLDS score was effective in predicting the risks of PRAEs. Passive smoking and previous comorbidities were the main predictors of PRAEs in our population. It seems that children with severe URI should be postponed to receive surgery for more than 15 days.
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Affiliation(s)
- Anouar Jarraya
- The anesthesiology Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Manel Kammoun
- The anesthesiology Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Saloua Ammar
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Wiem Feki
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Kamel Kolsi
- The anesthesiology Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
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Clark CM, Printz JN, Stahl LE, Phillips BE, Carr MM. Salivary cotinine levels in children with otolaryngological disorders. Int J Pediatr Otorhinolaryngol 2017; 102:103-107. [PMID: 29106854 DOI: 10.1016/j.ijporl.2017.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/18/2017] [Accepted: 08/22/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine if salivary cotinine, a biomarker for tobacco smoke exposure, is elevated more often or to a higher degree in children meeting criteria for tonsillectomy or tympanostomy tube insertion. METHODS Saliva samples were obtained from 3 groups of children for salivary cotinine measurement. Group 1 served as healthy controls. Group 2 consisted of subjects meeting tympanostomy tube criteria. Group 3 consisted of patients meeting tonsillectomy criteria. Environmental tobacco smoke (ETS) exposure was defined as a salivary cotinine concentration ≥1.0 ng/mL. Demographic data, smoke exposure history, and co-morbidities were also determined. RESULTS 331 patients were included, with 112 in Group 1, 111 in Group 2, and 108 in Group 3. No differences were encountered for smoke exposure by history or smoker's identity, salivary cotinine level, or frequency of positive cotinine results. 42.6% of Group 1 had positive salivary cotinine compared to 51.8% of Group 2 and 47.7% of Group 3. Group 1 had a mean salivary cotinine level of 2.42 ng/mL compared to 2.54 ng/mL in Group 2 and 2.60 ng/mL in Group 3. The frequency of positive cotinine levels was higher than expected based on parental history. Among subjects with positive cotinine levels, 93 had no ETS exposure, and 64 had ETS exposure by history. CONCLUSION Approximately 50% of children who undergo tonsillectomy and tympanostomy tube insertion have objective evidence of ETS exposure. Parental history underestimates passive smoke exposure, which can impact perioperative care.
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Affiliation(s)
- Christine M Clark
- The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA
| | - Jillian N Printz
- The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA
| | - Lauren E Stahl
- Department of Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA
| | - Brett E Phillips
- Department of Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA
| | - Michele M Carr
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26501, USA.
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Erhan ÖL, İleri A, Bulut OK, Özer AB. Passive Smoking Also Affects Recovery from Anaesthesia. Turk J Anaesthesiol Reanim 2017; 45:242-243. [PMID: 28868176 DOI: 10.5152/tjar.2017.46656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/05/2017] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ömer Lütfi Erhan
- Department of Anesthesiology And Reanimation, Fırat University School of Medicine, Elazığ, Turkey
| | - Abdurrahman İleri
- Department of Anesthesiology And Reanimation, Fırat University School of Medicine, Elazığ, Turkey
| | - Oğuz Kağan Bulut
- Department of Anesthesiology And Reanimation, Fırat University School of Medicine, Elazığ, Turkey
| | - Ayşe Belin Özer
- Department of Anesthesiology And Reanimation, Fırat University School of Medicine, Elazığ, Turkey
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Chiswell C, Akram Y. Impact of environmental tobacco smoke exposure on anaesthetic and surgical outcomes in children: a systematic review and meta-analysis. Arch Dis Child 2017; 102:123-130. [PMID: 27417307 PMCID: PMC5284464 DOI: 10.1136/archdischild-2016-310687] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 06/08/2016] [Accepted: 06/20/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Tobacco smoke exposure in adults is linked to adverse anaesthetic and surgical outcomes. Environmental tobacco smoke (ETS) exposure, including passive smoking, causes a number of known harms in children, but there is no established evidence review on its impact on intraoperative and postoperative outcomes. OBJECTIVES To undertake a systematic review of the impact of ETS on the paediatric surgical pathway and to establish if there is evidence of anaesthetic, intraoperative and postoperative harm. ELIGIBILITY CRITERIA PARTICIPANTS Children aged 0-18 years undergoing anaesthetic or surgical procedures, any country, English language papers. EXPOSURE ETS exposure assessed via questioning, observation or biological marker. OUTCOME MEASURES Frequency of respiratory and other adverse events during anaesthesia, surgery and recovery, and longer term surgical outcomes. RESULTS 28 relevant studies were identified; 15 considered anaesthetic outcomes, 12 surgical outcomes, and 1 a secondary outcome. There was sufficient evidence to demonstrate that environmental smoke exposure significantly increased risk of perianaesthetic respiratory adverse events (Pooled risk ratio 2.52 CI 95% 1.68 to 3.77), and some evidence that ear and sinus surgery outcomes were poorer for children exposed to ETS. CONCLUSIONS ETS exposure increases the risk of anaesthetic complications and some negative surgical outcomes in children, and this should be considered when planning surgery. Research is required to demonstrate whether changes in household smoking behaviour prior to surgery reduces risk of adverse outcomes, and to close the evidence gap around other outcomes such as wound healing and respiratory infections. TRIAL REGISTRATION NUMBER Review registration number 42014014557.
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Affiliation(s)
| | - Yasmin Akram
- Institute of Applied Health Research, Universityof Birmingham, Birmingham, UK
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Chau DF, Reddy A, Breheny P, Young AR, Ashford E, Song M, Zhang C, Taylor T, Younes A, Vazifedan T. Revisiting the applicability of adult early post-operative nausea and vomiting risk factors for the paediatric patient: A prospective study using cotinine levels in children undergoing adenotonsillectomies. Indian J Anaesth 2017; 61:964-971. [PMID: 29307901 PMCID: PMC5752782 DOI: 10.4103/ija.ija_303_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background and Aims: Post-operative vomiting (POV) in children remains a significant clinical problem. This prospective study aims to investigate the applicability of well-established adult early post-operative nausea and vomiting (PONV) risk factors on paediatric POV after adenotonsillectomies under regulated anaesthetic conditions. Methods: After Institutional Review Board approval, 213 children aged 3–10-year-old were enrolled. The participants had pre-operative questionnaires completed, followed protocolised anaesthetic plans and had saliva analysed for cotinine. The primary outcomes were POV as correlated with age, gender, family or personal history of PONV, motion sickness history, opioid use, surgical time, anaesthetic time and environmental tobacco smoke (ETS) exposure, as assessed by cotinine levels and questionnaire reports. Data on analgesics, antiemetics and POV incidence before post-anaesthesia care unit discharge were collected. Statistical analysis was done through multiple logistic regression. Results: A total of 200 patients finalised the study. Early POV occurred in 32%. Family history of PONV (odds ratio [OR] = 5.3, P < 0.01) and motion sickness history (OR = 4.4, P = 0.02) were highly significant risk factors. Age reached borderline statistical significance (OR = 1.4, P = 0.05). None of the other factors reached statistical significance. Conclusion: Early POV occurs frequently in paediatric patients undergoing adenotonsillectomies. In this paediatric-aged group, the incidence of POV was affected by the family history of PONV, and history of motion sickness. Age, female gender, opioid use, surgical and anaesthetic times did not affect the incidence of POV. ETS exposure, as assessed by cotinine levels and questionnaire reports, had no protective effect on early paediatric POV.
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Affiliation(s)
- Destiny F Chau
- Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Arundathi Reddy
- Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Patrick Breheny
- Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Anna Rebecca Young
- Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Eric Ashford
- Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Megan Song
- Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Christina Zhang
- Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Tammy Taylor
- Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Abbas Younes
- Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Turaj Vazifedan
- Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
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Simsek E, Karaman Y, Gonullu M, Tekgul Z, Cakmak M. The effect of passive exposure to tobacco smoke on perioperative respiratory complications and the duration of recovery. Braz J Anesthesiol 2016; 66:492-8. [PMID: 27591463 DOI: 10.1016/j.bjane.2015.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 03/10/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The incidence of perioperative respiratory complications and postoperative care unit recovery time investigated in patients with passive tobacco smoke exposure according to the degree of exposure. METHODS Total 270 patients ranging in age from 18 to 60 years with the ASA physical status I or II exposed and not exposed to passive tobacco smoke received general anesthesia for various elective surgical operations evaluated for the study. Patients divided into two groups as exposed and non-exposed to passive tobacco smoke, those exposed to passive smoke are also divided into two groups according to the degree of exposure. Patients taken to the postoperative care unit (PACU) at the end of the operation and monitorized until Modified Aldrete's Scores became 9 and more. Respiratory complications evaluated and recorded in intraoperative and postoperative period. RESULTS A total of 251 patients were enrolled; 63 (25.1%) patients had airway complications, 11 (4.4%) had complications intraoperatively and 52 (20.7%) patients had complications postoperatively. There has been found significant relation with passive tobacco smoke exposure and high incidences of perioperative and postoperative respiratory complications. The risk of cough, desaturation and hypersecretion complications were found to be increased depending on the degree of exposure. There was significant relation between the degree of passive smoke exposure and the duration of PACU stay. CONCLUSION Passive tobacco smoke exposed general anesthesia receiving patients also regarding to the degree of exposure having high rates of perioperative respiratory complications and prolongation of PACU stays when compared with unexposed patients.
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Affiliation(s)
- Esen Simsek
- Çanakkale State Hospital, Department of Anesthesiology and Reanimation, Çanakkale, Turkey.
| | - Yucel Karaman
- Tepecik Teaching and Research Hospital, Department of Anesthesiology and Reanimation, İzmir, Turkey
| | - Mustafa Gonullu
- Tepecik Teaching and Research Hospital, Department of Anesthesiology and Reanimation, İzmir, Turkey
| | - Zeki Tekgul
- Tepecik Teaching and Research Hospital, Department of Anesthesiology and Reanimation, İzmir, Turkey
| | - Meltem Cakmak
- Tepecik Teaching and Research Hospital, Department of Anesthesiology and Reanimation, İzmir, Turkey
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Simsek E, Karaman Y, Gonullu M, Tekgul Z, Cakmak M. [The effect of passive exposure to tobacco smoke on perioperative respiratory complications and the duration of recovery]. Rev Bras Anestesiol 2016; 66:492-8. [PMID: 27432528 DOI: 10.1016/j.bjan.2015.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 03/10/2015] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND The incidence of perioperative respiratory complications and postoperative care unit recovery time investigated in patients with passive tobacco smoke exposure according to the degree of exposure. METHODS Total 270 patients ranging in age from 18 to 60 years with the ASA physical status I or II exposed and not exposed to passive tobacco smoke received general anesthesia for various elective surgical operations evaluated for the study. Patients divided into two groups as exposed and non-exposed to passive tobacco smoke, those exposed to passive smoke are also divided into two groups according to the degree of exposure. Patients taken to the postoperative care unit (PACU) at the end of the operation and monitorized until Modified Aldrete's Scores became 9 and more. Respiratory complications evaluated and recorded in intraoperative and postoperative period. RESULTS A total of 251 patients were enrolled; 63 (25.1%) patients had airway complications, 11 (4.4%) had complications intraoperatively and 52 (20.7%) patients had complications postoperatively. There has been found significant relation with passive tobacco smoke exposure and high incidences of perioperative and postoperative respiratory complications. The risk of cough, desaturation and hypersecretion complications were found to be increased depending on the degree of exposure. There was significant relation between the degree of passive smoke exposure and the duration of PACU stay. CONCLUSION Passive tobacco smoke exposed general anesthesia receiving patients also regarding to the degree of exposure having high rates of perioperative respiratory complications and prolongation of PACU stays when compared with unexposed patients.
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Affiliation(s)
- Esen Simsek
- Çanakkale State Hospital, Department of Anesthesiology and Reanimation, Çanakkale, Turquia.
| | - Yucel Karaman
- Tepecik Teaching and Research Hospital, Department of Anesthesiology and Reanimation, İzmir, Turquia
| | - Mustafa Gonullu
- Tepecik Teaching and Research Hospital, Department of Anesthesiology and Reanimation, İzmir, Turquia
| | - Zeki Tekgul
- Tepecik Teaching and Research Hospital, Department of Anesthesiology and Reanimation, İzmir, Turquia
| | - Meltem Cakmak
- Tepecik Teaching and Research Hospital, Department of Anesthesiology and Reanimation, İzmir, Turquia
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