Tenuous airway in children with trisomy 21.
Multiple congenital anomalies are closely linked to Down syndrome (trisomy 21). Cardiac malformations are found in 40% of patients, a large number of whom will require a major surgical procedure. The importance of postextubation stridor in these children is frequently underestimated. A retrospective review of 99 trisomy 21 patients who underwent cardiovascular surgery revealed postextubation stridor in 24 (24.2%). Significant factors for the development of stridor included younger age (P=0.04), lower growth percentile for weight (P=0.03), and increased frequency of reintubation (P=0.04). Subglottic stenosis was found in 6 (6.1%). In 4 of these patients, an endotracheal tube of larger diameter than predicted for age was used. All 6 patients were less than the 10th percentile for weight. We conclude that Down syndrome patients deserve special considerations and modifications of standard intubation techniques for successful airway management.
de Jong
A L
AL
Department of Otolaryngology, Baylor College of Medicine and Texas Children's Hospital, Houston 77030, U.S.A.
Sulek
M
M
Nihill
M
M
Duncan
N O
NO
Friedman
E M
EM
D000367:Age Factors; D000402:Airway Obstruction / Q000209:etiology / Q000503:physiopathology; D001835:Body Weight; D006348:Cardiac Surgical Procedures; D002675:Child, Preschool; D004314:Down Syndrome / Q000150:complications*; D004867:Equipment Design; D005260:Female; D005544:Forecasting; D005931:Glottis / Q000473:pathology; D006128:Growth; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation; D007829:Laryngostenosis / Q000151:congenital / Q000209:etiology / Q000628:therapy; D008297:Male; D015999:Multivariate Analysis; D012119:Respiration; D012135:Respiratory Sounds / Q000209:etiology*; D019233:Retreatment; D012189:Retrospective Studies