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Paediatr Anaesth. 2016 Apr;26(4):356-62. doi: 10.1111/pan.12841. Epub 2016 Jan 9.

Preoperative evaluation and comprehensive risk assessment for children with Down syndrome.

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  • 1Division of Genetics & Metabolism, Children's National Health System, Washington, DC, USA.
  • 2Divisions of Anesthesiology, Sedation, and Perioperative Medicine, Children's National Health System, Washington, DC, USA.
  • 3Division of Neonatology, Children's National Health System, Washington, DC, USA.
  • 4Division of Cardiology, Children's National Health System, Washington, DC, USA.
  • 5Division of Critical Care Medicine, Children's National Health System, Washington, DC, USA.
  • 6Divisions of Pulmonary Medicine and Sleep Medicine, Children's National Health System, Washington, DC, USA.
  • 7Divisions of Hematology and Oncology, Children's National Health System, Washington, DC, USA.
  • 8Division of Neurosurgery, Children's National Health System, Washington, DC, USA.

Abstract

Down syndrome is a common chromosome disorder affecting all body systems. This creates unique physiologic concerns that can affect safety during anesthesia and surgery. Little consensus exists, however, on the best way to evaluate children with Down syndrome in preparation for surgery. We review a number of salient topics affecting these children in the perioperative period, including cervical spine instability, cardiovascular abnormalities, pulmonary hypertension, upper airway obstruction, hematologic disturbances, prematurity, low birth weight, and the use of supplements and alternative therapies. Recommendations include obtaining a complete blood count to detect an increased risk for bleeding or stroke, and cardiology evaluation to identify patients with pulmonary hypertension, as well as undiagnosed or residual heart disease. Pediatric cardiac anesthesiologists and intensivists should be involved as needed. The potential for cervical spine instability should be considered, and the anesthesiologist may wish to have several options available both for the medications and equipment used. The child's family should always be asked if he or she is on any nutritional supplements, as some products marketed to families may have secondary effects such as inhibition of platelet function. Using this evaluation in presurgical planning will allow physicians to better consider the individual circumstances for their patients with Down syndrome. Our goal was to optimize patient safety by choosing the most appropriate setting and perioperative personnel, and to mitigate those risk factors amenable to intervention.

© 2016 John Wiley & Sons Ltd.

KEYWORDS:

Down syndrome; anesthesia; perioperative; preoperative; surgery; trisomy 21

PMID:
26749540
[PubMed - in process]

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