Frequency of anesthesia‐related complications in children with Down syndrome under general anesthesia for noncardiac procedures

Abstract

Comprehensive reporting is needed to capture all significant adverse events. The incidences of bradycardia on induction, natural airway obstruction, and postintubation (or instrumentation) croup were significantly higher in the DS noncardiac group compared with the remaining population. Current anesthesia techniques and agents must be compared using quantitative QA data to ensure use of the safest options for each patient.

Hemodynamic changes in children with Down syndrome during and following inhalation induction of anesthesia with sevoflurane

“…Previously, Borland et al found that bradycardia was significantly more common in children with Down syndrome compared with other children receiving a variety of general anesthetics and agents, primarily halothane [12]. Roodman et al described three children with Down syndrome who became severely bradycardic and hypotensive during sevoflurane induction at end-tidal sevoflurane concentrations of 3.8% to 4.5%, and no airway compromise had occurred [13].…”

“…General anesthesia (GA) with sevoflurane inhalation induction is a widely used technique in young children, including those with Down Syndrome, due to its rapidity of induction and emergence, minimal airway irritation, and favorable hemodynamic stability [1][2][3][4][5][6][7]. Bradycardia and abnormal rhythm have been reported during induction of GA with halothane or sevoflurane, both in the general pediatric population and in children with Down syndrome [8][9][10][11][12][13]. The objective of this case-controlled retrospective study was to evaluate whether children with Down syndrome, compared with other children, are at increased risk of bradycardia and hypotension during and following sevoflurane induction.…”

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.…”

El niño con Síndrome de Down en la Unidad de Cuidados Intensivos

“…Se ha demostrado que la incidencia de complicaciones relacionadas con la anestesia general es significativamente mayor en estos pacientes para procedimientos no cardíacos, destacando la presencia de bradicardia grave, obstrucción de la vía aérea y estridor post instrumentalización 59 .…”