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Children exposed to secondhand tobacco or cooking smoke have very high rates of pain and complications after tonsillectomy
Date:6/1/2014

New research presented at this year's Euroanaesthesia meeting in Stockholm shows that children exposed to indoor coal-burning stoves and/or second-hand tobacco smoke are much more likely to suffer postoperative complications and excessive pain after tonsillectomies. The research is by Professor Daniel Sessler, Cleveland Clinic, Cleveland, Ohio, USA and Dr Onur Koyuncu, Mustafa Kemal University, Hatay, Turkey, and colleagues.

Almost half of the world's population uses solid fuel including biomass (wood, crop residues, and animal dung) or coal for heating and cooking. Because stoves are usually centrally positioned in homes and often the only source of heat, families tend to congregate around them and sleep nearby. Many stoves generate and release pollutants into household air including carbon monoxide. Children are also exposed to carbon monoxide via second-hand tobacco smoke, with estimates suggesting 40-70% of children are exposed worldwide.

Exposure to carbon monoxide results in carboxyhaemoglobin*, which may provoke postoperative complications. Elevated carboxyhaemoglobin concentrations may also increase pain sensitivity. The investigators therefore tested the primary hypothesis that children with high preoperative carboxyhaemoglobin concentrations have more postoperative complications and pain after tonsillectomies. Secondarily they tested the hypothesis that high carboxyhaemoglobin concentrations are associated with more pain and painkiller use.

100 Turkish children scheduled for elective tonsillectomy were divided into low and high carbon monoxide exposure groups: carboxyhaemoglobin ≤3 or ≥4 g/dl. The primary outcome was complications during the seven days after surgery which included bronchospasm, laryngospasm, persistent coughing, desaturation (low blood oxygen), the need for re-intubation, low blood pressure, postoperative bleeding, and reoperation. Pain was evaluated with Wong-Baker Faces pain scales, and suppl
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Contact: Daniel I. Sessler
DS@OR.org
216-870-2620
ESA (European Society of Anaesthesiology)
Source:Eurekalert

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