Anaesthesia Management for Edward's Syndrome (Trisomy 18)

Anesthesia for children with complete trisomy 18 (Edwards syndrome): A cohort review of 84 anesthesia encounters in nine patients

“…Micrognathia and potentially difficult airway management are known features of trisomy 18, 10 and all of our patients except one had documented abnormal external airway examinations. Similar to published case reports where airways were secured with relative ease, 1,10‐14 a satisfactory view of the glottis could be achieved on many occasions (Table 1). On the other hand, we encountered multiple cases of “difficult airways” where intubation required additional resources or where the inability to ventilate led to perioperative hypoxic cardiac arrest (Figure 4).…”

“…The limited anesthesia literature regarding trisomy 18 patients highlights the abnormal airway anatomy including micrognathia, high arched palate, and short neck and warns about potential difficulty with mask ventilation and intubation. Case reports, however, often describe an uneventful airway management and perioperative course 1,10‐14 . We found three reports of anesthetic complications: Mifsud et al described a case of intraoperative bradycardia in a 3‐year‐old patient with acute intestinal obstruction, multiple cardiac defects, and secondary pulmonary hypertension.…”

“…Case reports, however, often describe an uneventful airway management and perioperative course. 1,[10][11][12][13][14] We found three reports of anesthetic complications: Mifsud et al described a case of intraoperative bradycardia in a 3-year-old patient with acute intestinal obstruction, multiple cardiac defects, and secondary pulmonary hypertension. Bradycardia followed a relatively easy intubation and was corrected with 200 mcg atropine.…”

“…Trisomy 18 or Edwards syndrome is the second most common autosomal anomaly and aneuploidy 1 and the second most common multiple malformation syndrome 2 with a prevalence between 1/3000 and 1/10 000 live births 3,4 . The syndrome encompasses malformations of the central nervous, cardiac, respiratory, gastrointestinal, and genitourinary systems.…”

Anesthetic Management of Inguinal Hernia Surgery Using a Second-Generation Supraglottic Airway in a Patient With Trisomy 18: A Case Report

“…SGAs can be effectively used as a primary airway for superficial surgical procedures in children with anticipated difficult intubation or ventilation [ 3 ]. In children with trisomy 18, a size-1 laryngeal mask airway (LMA) for a two-month-old boy weighing 3 kg and a size-2 LMA for a three-year-old girl weighing 10 kg were reported to be effective for general anesthesia [ 5 , 6 ]. One review claimed that SGA insertion and subsequent ventilation are usually independent of anatomical factors and other airway techniques such as facemask ventilation and laryngoscope-guided tracheal intubation [ 8 ].…”