Tonsillectomy Troubles: Coal Stoves and Secondhand Smoke

Children exposed to secondhand smoke and coal burning stoves had greater pain and more complications after tonsillectomy

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) In many places around the world, people use coal-burning stoves to cook and stay warm. These stoves release a gas, also found in tobacco smoke, that might lead to issues after kids get their tonsils removed.

Recent research showed that children of parents who smoke tobacco or use indoor coal or wood-burning stoves may be at a greater risk for medical difficulties after a tonsillectomy surgery. 

Children exposed to secondhand smoke after surgery had higher levels of pain and healed slower than kids not exposed to secondhand smoke.

"Quit smoking for your children's health."

A very large portion of the world’s population uses solid fuels like biomass (wood, crop residues and animal dung) and coal for heating and cooking in their homes. Stoves are often centrally located in the home, and families tend to gather and sleep nearby to keep warm or cook.

Stoves create and release varying levels of carbon monoxide (CO) into the household’s air, and an estimated 40 to 70 percent of children worldwide are exposed to CO via secondhand tobacco smoke.

New research by Professor Daniel Sessler, MD, of the Cleveland Clinic, and colleagues stated that the amount of exposure to CO might possibly lead to increases in pain and an inability to heal in children who recently underwent tonsillectomy surgery.

Tonsillectomy is a common surgery used to relieve repeated sore throat and ear infections.

Direct contact with high levels of CO in the children’s homes resulted in a form of poisoning, known as carboxyhaemoglobin.

Carboxyhaemoglobin occurs when hemoglobin (red blood cells) bonds with carbon monoxide instead of oxygen, causing the body to become oxygen deprived. When children’s bodies are oxygen poor, they are at a higher risk for complications after surgery.

The researchers reviewed the cases of 100 Turkish children who were scheduled for elective tonsillectomy and divided these children into two groups (low and high carboxyhaemoglobin) based upon the amount of CO exposure in the child’s home.

Thirty-six of these children were placed in the low carboxyhaemoglobin group (average of 1.8 grams per deciliter), and 64 patients were in the high exposure group (average of 6.4 grams per deciliter).

The researchers found that children exposed to higher levels of CO showed more signs of carboxyhaemoglobin during the seven days after their tonsillectomy surgery. The signs of carboxyhaemoglobin complications were identified by:

  • Bronchospasm (asthma)
  • Laryngospasm (frozen vocal chords)
  • low blood pressure
  • postoperative bleeding
  • desaturation (low blood oxygen)
  • a need for re-intubation (a second insertion of a tube in the throat or trachea)
  • persistent coughing
  • re-operation

Indoor coal-burning stoves were used in the homes of 89 percent of the children who fell within the high carboxyhaemoglobin category, versus only 72 percent of the homes of children in the low category.

Direct exposure to secondhand cigarette smoke was reported by 54 percent of the children’s families with high levels of carboxyhaemoglobin, versus only 24 percent of children in the low category.

Complications after surgery occurred in 47 percent of children in the high carboxyhaemoglobin category, versus 14 percent of children in the low category. Coughing and desaturation were listed as the two most common complications.

The children’s pain levels were measured using the Wong-Baker Faces pain rating scale and by how much of the painkiller tramadol (sometimes sold under the brand name Ultram) the children took at four hours and 24 hours after surgery.

Use of tramadol was lower in those with low CO exposure at both the four-hour and the 24-hour post-surgery mark. Children in the low category took an average of 3.5 milligrams of tramadol, whereas children in the high category took an average of 6.0 milligrams.

The investigators concluded that “children with substantial environmental CO exposure who were given general anesthesia had more postoperative complications, more pain, and needed more analgesics [painkillers] than those with less exposure.”

The researchers admitted that they relied on the children’s parents and caregivers to identify and measure secondhand smoke exposure via a questionnaire, and acknowledged the possibility “that parents failed to accurately or completely report passive smoking exposure at home for various reasons, including personal embarrassment."

This research was presented June 1 at Euroanaesthesia 2014, a congress of the European Society of Anaesthesiology (ESA), and was supported by internal funding. No conflicts of interest were declared.

Review Date: 
June 4, 2014
Last Updated:
June 6, 2014