Anaesthetic considerations in down’s syndrome: experience with 100 patients and a review of the literature

Abstract

Down's Syndrome (Trisomy 21, T21) occurs in approximately 0.15 per cent of live births. In addition to the stigmata of the syndrome, other congenital defects are frequently found in these patients. Cardiac lesions are particularly prominent.To determine the complications associated with anaesthesia and surgery we examined the records of 100 consecutive patients (58 males, 42 females) who underwent surgery with general anaesthesia during a two year period, from March 1978-March 1980 In addition to the cardiac lesions, the low birth weight of Trisomy 21 infants, increased suceptibility to infections, atlanto-occipital dislocation, and reduced central nervous system catecholamine levels might be expected to result in an increased incidence of complications.This study of 100 patients with Trisomy 21 (T21) indicates that the incidence of complications is low. However, the anaesthetist must understand the pathophysiology of T21 in order to provide optimal anaesthetic care.

Down syndrome: Common otolaryngologic manifestations

“…Other medical problems that could affect the anesthetic results include pulmonary hypertension, polycythemia in the neonatal population, and thyroid function abnormalities. Although Kobel et al [1982] reported no differences in regard to the response of 100 patients with DS who inhaled anesthetic agents, Borland et al [2004] reviewed 930 anesthetic procedures in children with DS and found that the most common anesthetic-related complications included bradycardia, which was severe in 3.66%, airway obstruction in 1.83%, difficult intubation in 0.54%, and post-intubation croup in 1.83%. Although the total number of children reviewed was small, Mitchell et al [2003] found a 27% incidence of postoperative complications in 13 children who required PE tube placement.…”

“…An association between DS, stridor, and/or subglottic stenosis is frequently discussed in the anesthesia literature [Kobel et al, 1982;Sherry, 1983;Miller et al, 1986;Borland et al, 2004]. It has been common practice over the years to use a smaller endotracheal tube when intubating children with DS.…”

11 Anesthesia for Scoliosis Surgery

“…Cardiac defects are present in 40 to 50% of patients with DS. 117 Combinations of the foregoing abnormalities predispose patients undergoing spine surgery to upper-airway obstruction, making their airway management difficult. Normal films of the cervical spine in patients with DS are reassuring, particularly during intubation and positioning for scoliosis-related procedures.…”

Anaesthetic Management in a Congenital Catharact Patient with Down Syndrome

“…In addition to the stigmata of the syndrome, other congenital defects are frequently found in these patients. Cardiac lesions are particularly prominent 3 . Congenital heart disease such as endocardial cushion defects, VSD, ASD, isolated secondum atrial defect, PDA, Tetralogy of Fallot.Children with Down syndrome are more prone to sleep apnea and airway obstruction due to a large tongue, short neck and laryngomalacia 4 .There is also increased incidence of atlanto axial instability and risk of spinal cord injury.…”