The impact of passive smoking on perioperative outcomes among infants and children undergoing ambulatory surgery: An observational study from a low-resource country

Passive smoking among infants and children is still common in low-resource countries and may lead to several paediatric comorbidities. The aim of this study is to assess its impact on anaesthetic and surgical outcomes. In this prospective observational study, we included all children aged 6 months to 6 years, having American Society of Anaesthesiologists (ASA) I-II classes, and undergoing ambulatory ilioinguinal surgery. Patients were divided into two groups according to their environmental tobacco exposure. The anaesthesia protocol and surgical procedures were standardised for all patients. Demographic parameters were comparable in both groups. Passive smoking increased the risk of preoperative anxiety (risk ratio = 1.857; 95% confidence interval = 1.02-3.37). The incidence of perioperative respiratory adverse events was significantly increased from 14.8% among non-exposed children to 29.2% among the exposed (p = 0.003; risk ratio = 2.368; 95% confidence interval = 1.28-3.28). Passive smoking increased the incidence of delayed awakening from 19.4% to 38% (p = 0.0027; risk ratio = 1.76; 95% confidence interval = 1.04-5.34), and emergence delirium from 43.5% to 56.2% (p = 0.023; risk ratio = 1.669; 95% confidence interval = 1.037-2.684). Higher risks for hospital admission (risk ratio = 2.91; 95% confidence interval = 1.40-6.06), and delayed wound healing (risk ratio = 3.65; 95% confidence interval: 1.48-9.23) were correlated with the tobacco smoke exposure. Children exposed to the tobacco smoke have higher anaesthetic and surgical risks and may require particular cautions during their perioperative management.