The Effect of Tobacco Smoke on Children Undergoing General Anesthesia and Surgery

Abstract

group are less frequently medicated with stimulants. 2 Third, contrary to the authors' statement, Baltimore County's median per capita income in the latest national census was well above the national average. 3 Fourth, rhetoric on the DSM-IV classification of ADHD as being "in the eye of the beholder" does not add to the scientific process at all. Fifth, if anything is a "guesstimate" of medication usage, it is not population-based estimates from multiple, large datasets, but the extrapolation from production quotas.To get beyond descriptive epidemiology, American researchers will have to develop outcome studies that assess the following issues: 1) the extent of duration of treatment; 2) effectiveness under usual practice conditions with outcomes that include school performance and social adjustment as well as symptom improvement; 3) long-term effectiveness of first-line treatments; 4) extent of additional medications or switches to second-line treatments; 5) parental satisfaction with treatment.Although this research would have been daunting in the past, the advent of computerization, managed care health information systems, and newly emerging practice research networks make us hopeful. Longitudinal studies in large cohorts can produce systematic information that will put Dr Diller and Dr Morrow's concerns into a scientific framework. When that happens, their rhetoric will be replaced by benefit-to-risk assessment data. These outcome data can then be used to keep our clinical practices in synch with our humanistic values. REFERENCES1. Wolraich ML, Hannah JN, Pinnock TY, Baumgaertel A, Brown J. Comparison of diagnostic criteria for attention-deficit hyperactivity disorder in a county-wide sample.

Reducing pediatric exposure to environmental tobacco smoke: The effects of pediatric exposure to environmental tobacco smoke and the role of pediatric perioperative care

“…Children exposed to ETS spend longer in PACU 6 and have an increased incidence of unplanned overnight admissions. 7 There is little evidence on the causes of these risks, although some pathophysiology can be extrapolated from the effect of tobacco smoke on smokers themselves. In the short term, cigarette smoke increases mucus production, reduces the efficacy of the mucociliary escalator, and limits airflow by bronchoconstriction.…”

“…Children exposed to ETS spend longer in PACU 6 and have an increased incidence of unplanned overnight admissions 7 …”