Lesson 6: Trisomy 21 (Down Syndrome)

Trisomy 21 (Down Syndrome)

  • Most common chromosomal disorder.
  • Caused by an extra copy of chromosome 21.
  • Increased prevalence in older mothers.

Anesthetic Considerations

  • Airway Management:

    • Risk for difficult ventilation/intubation:
    • Small mouth
    • Large tongue
    • Narrow, high-arched palate
    • Midface hypoplasia
    • Atlantoaxial instability (C1 & C2 subluxation): Avoid neck flexion.
    • Preoperative cervical spine examination recommended.
    • Subglottic stenosis: Increased risk of postintubation croup.
    • Use smaller endotracheal tube (ETT).
    • Obstructive sleep apnea risk.

  • Cardiovascular:

    • Common co-existing congenital heart disease:
    • Most common: Atrioventricular septal defect (AVSD).
    • Second most common: Ventricular septal defect (VSD).
    • Bradycardia common during sevoflurane induction: Treatment includes anticholinergic.
    • Caution with sevoflurane dosage to prevent profound bradycardia.
    • Low circulating catecholamines.

Other Clinical Concerns

  • Intellectual disability.
  • Epilepsy.
  • Strabismus.
  • Low muscle tone (hypotonia).
  • Hyperflexible joints: Caution with positioning.
  • Gastroesophageal reflux disease (GERD).
  • Thyroid disease.
  • Increased incidence of leukemia.