ENVIRONMENTAL TOBACCO-SMOKE - A RISK FACTOR FOR PEDIATRIC LARYNGOSPASM

Adult patients who smoke are known to have airway complications during general anesthesia. The objective of this study was to explore the re lationship between environmental tobacco smoke (ETS) exposure in the h ome and laryngospasm during general anesthesia in pediatric patients. A retrospective, cohort study was performed on pediatric ambulatory pa tients in the day surgery center and main operating room of a universi ty hospital. We studied 310 consecutive pediatric patients (all ASA ph ysical status I) who underwent an outpatient elective ear, nose, and t hroat or urologic surgical procedure in the spring and summer of 1994, and received inhalation induction by mask with halothane. Laryngospas m was identified from quality management and anesthetic records, and i ncluded only those patients whose records indicated that succinylcholi ne was given because of oxygen desaturation and inability to ventilate . Patients' families were questioned within 1 wk after surgery as to t he number of smokers in each child's household. Of 96 children with ET S exposure, 9 (9.4%) developed laryngospasm. Of the 214 patients witho ut domestic ETS exposure, 2 (0.9%) developed laryngospasm. The relativ e risk for developing laryngospasm was 10 times higher in the ETS-expo sed patients, compared with the non-ETS-exposed group (95% confidence interval = 2.2-45.6; P < 0.001). We conclude that ETS exposure is a st rong risk factor for laryngospasm in infants and children during gener al anesthesia.