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


This article reviews the problem of exposure to environmental tobacco smoke (ETS) for paediatric patients and discusses our potential as anaesthetists to help make behavioural change.

The risks of exposure to ETS include an increased rate of SIDS, bacterial meningitis, lower respiratory tract infections and presentations with wheeze or asthma. Perioperatively, exposure to ETS increases the rate of adverse respiratory events (such as laryngospasm), increases duration of stay in PACU and the rate of unplanned overnight stays.

The authors conducted a national survey of screening for exposure to ETS in children presenting for a procedure under GA in the UK. They found a low number of hospitals that screen for ETS (6 out of 34 unit) with only 2 offering formal smoking cessation.

They present the Very Brief Advice Model for screening:

  • Ask and record smoking status
  • Advise about health benefits of quitting to smoker and child
  • Act on response and refer for support


This article acts as a simple review of the evidence regarding ETS in children, without being a formal literature review. It reminds us of the importance of screening and our role in potential health promotion.


Reviewed by Patrick Cowie