Healthcare (Basel, Switzerland) · 2026
Impact of Passive Smoking on Vital Signs, Motor Activity, and Agitation in Children Undergoing Dental Extractions Under Sedation: A Short-Term Cohort Study.
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Kaplan Elif Buse, Avşar Aysun
Аннотация
BACKGROUND AND AIM: Passive smoking (PS) is a well-established risk factor associated with systemic and oral health impairments in children. However, its influence on perioperative physiological stability and recovery profiles during pediatric dental sedation remains insufficiently elucidated. This study investigated the association between PS exposure and perioperative vital parameters, recovery characteristics, and emergence behavioral outcomes in children undergoing dental extractions under sedation.
METHODS: This prospective cohort study (ClinicalTrials.gov: NCT06780189) included 100 ASA I children aged 4-6 years scheduled for primary molar extraction under midazolam-remifentanil-propofol sedation. Participants were stratified into three groups: no exposure, caregiver and household exposure, and household exposure only. An exposure-related relationship was evaluated based on daily household cigarette consumption. Perioperative vital signs (HR, blood pressure, and SpO2) were continuously monitored. Postoperative recovery and emergence profiles were assessed using the Modified Aldrete Recovery Score (MASS), Richmond Agitation-Sedation Scale (RASS), and Pediatric Anesthesia Emergence Delirium (PAED) scale.
RESULTS: Children exposed to PS demonstrated significantly lower SpO2 levels across all perioperative phases compared with non-exposed counterparts (p < 0.001), reflecting an exposure-related effect. In contrast, no statistically significant differences were observed in cardiovascular parameters (p > 0.05). Recovery time was significantly prolonged in PS-exposed children (p = 0.002). Furthermore, PS exposure was associated with significantly higher RASS and PAED scores, indicating increased agitation and emergence delirium (p < 0.001).
CONCLUSIONS: Passive smoking adversely affects perioperative oxygenation, delays recovery, and exacerbates emergence neurobehavioral disturbances in children undergoing dental sedation. Environmental tobacco exposure must be integrated into preoperative risk assessments.
METHODS: This prospective cohort study (ClinicalTrials.gov: NCT06780189) included 100 ASA I children aged 4-6 years scheduled for primary molar extraction under midazolam-remifentanil-propofol sedation. Participants were stratified into three groups: no exposure, caregiver and household exposure, and household exposure only. An exposure-related relationship was evaluated based on daily household cigarette consumption. Perioperative vital signs (HR, blood pressure, and SpO2) were continuously monitored. Postoperative recovery and emergence profiles were assessed using the Modified Aldrete Recovery Score (MASS), Richmond Agitation-Sedation Scale (RASS), and Pediatric Anesthesia Emergence Delirium (PAED) scale.
RESULTS: Children exposed to PS demonstrated significantly lower SpO2 levels across all perioperative phases compared with non-exposed counterparts (p < 0.001), reflecting an exposure-related effect. In contrast, no statistically significant differences were observed in cardiovascular parameters (p > 0.05). Recovery time was significantly prolonged in PS-exposed children (p = 0.002). Furthermore, PS exposure was associated with significantly higher RASS and PAED scores, indicating increased agitation and emergence delirium (p < 0.001).
CONCLUSIONS: Passive smoking adversely affects perioperative oxygenation, delays recovery, and exacerbates emergence neurobehavioral disturbances in children undergoing dental sedation. Environmental tobacco exposure must be integrated into preoperative risk assessments.