Wildfire Smoke Exposure is Associated with Adverse Respiratory Events Under General Anesthesia in At-Risk Pediatric Patients

Atmospheric particulate matter and hypoxaemia in Korean children receiving general anaesthesia: A retrospective analysis

BACKGROUND

The association between the concentration of atmospheric particulate matter on the day of surgery and the occurrence of intra-operative hypoxaemia in children receiving general anaesthesia is unclear.

OBJECTIVE

To investigate the association between the exposure to particulate matter on the day of surgery and the occurrence of intra-operative hypoxaemia, defined as a pulse oximetry oxygen saturation of less than 90% for more than 1 min, in children.

DESIGN

Retrospective study.

SETTING

Single-centre.

PARTICIPANTS

Children aged 18 years or younger who received general anaesthesia between January 2019 and October 2020.

INTERVENTION

Information on daily levels of particulate matter with a diameter 10 μm or less and 2.5 μm or less measured within a neighbourhood corresponding to the area defined by the hospital's zip code was obtained from publicly available air-quality data.

MAIN OUTCOME MEASURES

The primary outcome was intra-operative hypoxaemia, defined as a pulse oximetry oxygen saturation of less than 90% lasting for more than 1 min, manually verified by anaesthesiologists using vital sign registry data extracted at 2 s intervals.

RESULTS

Of the patients finally analysed, 3.85% (489/13 175) experienced intra-operative hypoxaemia. Higher levels of particulate matter 10 μm or less in diameter (≥81 μg m -3 , 17/275, 6.2%) were associated with an increased occurrence of intra-operative hypoxaemia compared with lower particulate matter concentrations [<81 μg m -3 , 472/12 900, 3.7%; adjusted odds ratio, 1.71; 95% confidence interval (CI), 1.04 to 2.83; P  = 0.035].

CONCLUSION

The level of particulate matter on the day of surgery pose a risk of intra-operative hypoxaemia in children receiving general anaesthesia. If the concentrations of particulate matter 10 μm or less in diameter on the day of surgery are high, children receiving general anaesthesia should be managed with increased caution.

Preoperative Exposure to Fine Particulate Matter and Risk of Postoperative Complications: A Single Center Observational Cohort Bayesian Analysis

Background & Objectives

While exposure to fine particulate matter air pollution (PM 2.5 ) is known to cause adverse health effects, its impact on postoperative outcomes in US adults remains understudied. Perioperative exposure to PM 2.5 may induce inflammation that insidiously interacts with the systemic inflammatory response after surgery, leading to higher postoperative complications.

Methods

We conducted a single center, retrospective cohort study using data from 64,313 surgical patients living along Utah's Wasatch Front and undergoing elective surgical procedures at a single academic medical center from 2016-2018. Patients' addresses were geocoded and linked to daily Census-tract level PM 2.5 estimates preoperatively. We hypothesized that elevated PM 2.5 concentrations in the seven days prior to surgery would be associated with an increase in a bundle of major postoperative complications. A hierarchical Bayesians regression model was fit adjusting for age, sex, season, neighborhood disadvantage, and the Elixhauser index of comorbidities.

Results

Postoperative complications increased in a dose-dependent manner with higher concentrations of PM 2.5 exposure, with a relative increase of 7% in the odds of complications for every 10ug/m3 increase in the highest single-day 24-hr PM 2.5 exposure during the 7 days prior to surgery. The association persisted after controlling for comorbidities and potential confounders; our inferences were robust to modeling choices and sensitivity analysis.

Discussion & Conclusion

In this large Utah cohort, exposure to elevated PM 2.5 concentrations in the week before surgery was associated with increased postoperative complications in a dose-dependent manner, suggesting a potential impact of air pollution on surgical outcomes. These findings merit replication in larger datasets to identify populations at risk and to define the interaction and impact of different pollutants. PM 2.5 exposure is a potential perioperative risk factor and, given the unmitigated air pollution in urban areas, a global health concern.

"Air That Once Was Breath" Part 2: Wildfire Smoke and Airway Disease - "Climate Change, Allergy and Immunology" Special IAAI Article Collection: Collegium Internationale Allergologicum Update 2023

BACKGROUND

Population growth and climate change have led to more frequent and larger wildfires, increasing the exposure of individuals to wildfire smoke. Notably, asthma exacerbations and allergic airway sensitization are prominent outcomes of such exposure.

SUMMARY

Key research questions relate to determining the precise impact on individuals with asthma, including the severity, duration, and long-term consequences of exacerbations. Identifying specific risk factors contributing to vulnerability, such as age, genetics, comorbidities, or environmental factors, is crucial. Additionally, reliable biomarkers for predicting severe exacerbations need exploration. Understanding the long-term health effects of repeated wildfire smoke exposures in individuals with asthma and addressing healthcare disparities are important research areas.

KEY MESSAGES

This review discusses the need for comprehensive research efforts to better grasp wildfire smoke-induced respiratory health, particularly in vulnerable populations such as farmworkers, firefighters, pregnant women, children, the elderly, and marginalized communities. Effective mitigation would require addressing the current limitations we face by supporting research aimed at a better understanding of wildfire smoke-induced airway disease.

Health Impacts of Wildfire Smoke on Children and Adolescents: A Systematic Review and Meta-analysis

PURPOSE OF REVIEW

Wildfire smoke is associated with human health, becoming an increasing public health concern. However, a comprehensive synthesis of the current evidence on the health impacts of ambient wildfire smoke on children and adolescents, an exceptionally vulnerable population, is lacking. We conduct a systematic review of peer-reviewed epidemiological studies on the association between wildfire smoke and health of children and adolescents.

RECENT FINDINGS

We searched for studies available in MEDLINE, EMBASE, and Scopus from database inception up to October 11, 2022. Of 4926 studies initially identified, 59 studies from 14 countries were ultimately eligible. Over 33.3% of the studies were conducted in the USA, and two focused on multi-countries. The exposure assessment of wildfire smoke was heterogenous, with wildfire-specific particulate matters with diameters ≤ 2.5 µm (PM2.5, 22.0%) and all-source (22.0%) PM2.5 during wildfire period most frequently used. Over half of studies (50.6%) focused on respiratory-related morbidities/mortalities. Wildfire smoke exposure was consistently associated with enhanced risks of adverse health outcomes in children/adolescents. Meta-analysis results presented a pooled relative risk (RR) of 1.04 (95% confidence interval [CI], 0.96-1.12) for all-cause respiratory morbidity, 1.11 (95% Ci: 0.93-1.32) for asthma, 0.93 (95% CI, 0.85-1.03) for bronchitis, and 1.13 (95% CI, 1.05-1.23) for upper respiratory infection, whilst - 21.71 g for birth weight (95% CI, - 32.92 to - 10.50) per 10 µg/m3 increment in wildfire-specific PM2.5/all-source PM2.5 during wildfire event. The majority of studies found that wildfire smoke was associated with multiple adverse health outcomes among children and adolescents, with respiratory morbidities of significant concern. In-utero exposure to wildfire smoke may increase the risk of adverse birth outcomes and have long-term impacts on height. Higher maternal baseline exposure to wildfire smoke and poor family-level baseline birthweight respectively elevated risks in preterm birth and low birth weight associated with wildfire smoke. More studies in low- and middle-income countries and focusing on extremely young children are needed. Despite technological progress, wildfire smoke exposure measurements remain uncertain, demanding improved methodologies to have more precise assessment of wildfire smoke levels and thus quantify the corresponding health impacts and guide public mitigation actions.

It's time to stop using nitrous oxide for pediatric mask induction

BACKGROUND

Mask induction of anesthesia for pediatric patients has included the use of nitrous oxide since the inception of pediatric anesthesia. However, the use of nitrous oxide precludes adequate preoxygenation. Additionally, pediatric physiology (less Functional Residual Capacity, higher oxygen consumption), increased risk of laryngospasm and lack of intravenous access increase the risk of a severe airway complication in the event of airway occlusion. Nitrous oxide does not facilitate tranquil mask placement on an unwilling child and does not meaningfully speed mask induction. Exposure to nitrous oxide has potential occupational health concerns and nitrous oxide has significant environmental detriment.

CONCLUSION

Utilizing other, evidence-based, techniques to facilitate tranquil mask placement will assure that patients have a pleasant induction experience and avoiding nitrous oxide will reduce the environmental impact, as well as improve the safety of, pediatric mask induction.

The intersection of pediatric surgery, climate change, and equity

Climate change is occurring at an unprecedented rate. Recent years have seen heatwaves, wildfires, floods, droughts, and re-emerging infectious diseases fueled by global warming. Global warming has also increased the frequency and severity of surgical disease, particularly for children, who bear an estimated 88% of the global burden of disease attributable to climate change. Health care delivery itself weighs heavily on the environment, accounting for nearly 5% of global greenhouse gas emissions. Within the health care sector, surgery and anesthesia are particularly carbon intensive. The surgical community must prioritize the intersection of climate change and pediatric surgery in order to address pediatric surgical disease on a global scale, while reducing the climate impact of surgical care delivery. This review defines the current state of climate change and its effects on pediatric surgical disease, discusses climate justice, and outlines actions to reduce the climate impact of surgical services. LEVEL OF EVIDENCE: Level V.