Chiswell Christopher, Akram Yasmin
Department of Public Health, Birmingham Children's Hospital, Birmingham, UK.
Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Arch Dis Child. 2017 Feb;102(2):123-130. doi: 10.1136/archdischild-2016-310687. Epub 2016 Jul 14.
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.
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.
Children aged 0-18 years undergoing anaesthetic or surgical procedures, any country, English language papers.
ETS exposure assessed via questioning, observation or biological marker.
Frequency of respiratory and other adverse events during anaesthesia, surgery and recovery, and longer term surgical outcomes.
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.
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.
Review registration number 42014014557.
成人接触烟草烟雾与不良麻醉和手术结局相关。环境烟草烟雾（ETS）暴露，包括被动吸烟，会给儿童带来一些已知危害，但尚无关于其对术中及术后结局影响的既定证据综述。
对ETS对小儿外科手术路径的影响进行系统综述，并确定是否有证据表明存在麻醉、术中和术后危害。
纳入标准
年龄在0至18岁之间、正在接受麻醉或外科手术的儿童，来自任何国家，英文论文。
通过询问、观察或生物标志物评估ETS暴露情况。
麻醉、手术和恢复期间呼吸及其他不良事件的发生频率，以及长期手术结局。
共识别出28项相关研究；15项考虑了麻醉结局，12项考虑了手术结局，1项考虑了次要结局。有充分证据表明，环境烟雾暴露显著增加围麻醉期呼吸不良事件的风险（合并风险比2.52，95%置信区间1.68至3.77），并有一些证据表明，暴露于ETS的儿童耳部和鼻窦手术结局较差。
ETS暴露会增加儿童麻醉并发症和一些负面手术结局的风险，在规划手术时应予以考虑。需要开展研究以证明术前家庭吸烟行为的改变是否能降低不良结局的风险，并缩小围绕伤口愈合和呼吸道感染等其他结局的证据差距。
综述注册号42014014557。
