Frequency of anesthesia-related complications in children with Down syndrome under general anesthesia for noncardiac procedures.
BACKGROUND
Craniofacial and cardiac anomalies of Down syndrome (DS; trisomy 21) would seem to place these patients at higher risk of anesthesia-related complications (ARCs), but to date no comprehensive large-scale study has quantified this risk.


METHODS
A retrospective chart review was conducted on all patients with DS undergoing anesthesia between April 1, 1988, and May 31, 1995, at Children's Hospital of Pittsburgh. In addition, the Anesthesiology Department Quality Assurance (QA) System database of concurrently collected anesthesia information on all patients undergoing anesthesia at the hospital since 1985 was analyzed.


RESULTS
Of the total 74,021 anesthetic encounters during the study period, 930 anesthetic encounters in 488 patients with DS undergoing noncardiac procedures were analyzed. The most frequent ARCs were bradycardia (severe) (3.66%), natural airway obstruction (1.83%), difficult intubation (0.54%), postintubation croup (1.83%), and bronchospasm (0.43%).


CONCLUSIONS
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.
Department of Pediatric Anesthesiology, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. blckrose@pitt.edu
Lawrence M
LM
Borland
Jacqueline
J
Colligan
Barbara W
BW
Brandom
D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000402:Airway Obstruction / Q000209:etiology*; D000768:Anesthesia, General / Q000009:adverse effects*; D001919:Bradycardia / Q000209:etiology*; D001986:Bronchial Spasm / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003440:Croup / Q000209:etiology; D004314:Down Syndrome / Q000601:surgery*; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000009:adverse effects; D008297:Male; D016017:Odds Ratio; D010414:Pennsylvania; D012135:Respiratory Sounds / Q000209:etiology; D012189:Retrospective Studies