Anaesthesia in Downs Syndrome:Associated Conditions,Special Problems

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

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ANESTHESIA AND ASSOCIATED DISEASES

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Dr Sunita Goel
Lecturer in Anaesthesiology
BJ Wadia Childrens hospital

Downs syndrome :

Downs syndrome (Trisomy 21: T21) is common in 1.5/1000 births. Mental retardation is invariably present but varies in severity from patient to patient.

Associated conditions:

Congenital heart disease: 60% with AV canal, VSD, PDA, TOF
Respiratory infections are common, may be related to genetic anomaly, an immune deficiency and /or social and institutional implications.
Atlanto-axial joint instability 12% leads to cervical spinal cord injury.
Duodenal atresia of the newborn is common.
Congenital subglottic stenosis is common
Polycythemia is a frequent finding in the neonate and may require phlebotomy to relieve circulatory failure.
Thyroid hypofunction is common as the child grows older.
Sleep apnea is common.

Special problems :

Airway: The large tongue and small nasopharynx predispose to respiratory obstruction, particularly during mask anesthesia
and recovery stages. Congenital subglottic stenosis predisposes to post-operative stridor.
Lungs: Is there any acute infection present, which requires therapy prior to surgery?
Problem of associated cardiac disease.
Atlanto-axial joint instability may predispose to injury during intubation.
Retarded children are more difficult to manage during induction of anesthesia.
Are there any other diseases present?

Note: Children with Down's Syndrome are particularly sensitive to the effects of atropine.

Next : Anaesthesia in Cystic Fibrosis and Plastic Surgery

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