title: Bradycardia during induction of anesthesia with sevoflurane in children with Down syndrome.
abstract: BACKGROUND
  Bradycardia is a complication associated with inhaled induction of anesthesia with halothane in children with Down syndrome. Although bradycardia has been reported after anesthetic induction with sevoflurane in these children, the incidence is unknown.
  
  
  OBJECTIVE
  In this study we compared the incidence and characteristics of bradycardia after induction of anesthesia with sevoflurane in children with Down syndrome to healthy controls.
  
  
  METHODS
  We reviewed electronic anesthetic records of 209 children with Down syndrome and 268 healthy control patients who had inhaled induction of anesthesia with sevoflurane over an 8-year period. Data extracted from the medical record included demographics, history of congenital heart disease, heart rate, oxyhemoglobin saturation, expired sevoflurane concentrations, arterial blood pressure, and any treatment of bradycardia during the first 360 seconds after the start of induction of anesthesia. Bradycardia and hypotension were defined as heart rate and arterial blood pressure below the critical limits recommended for activating a pediatric rapid response team to the bedside of a hospitalized child for quick intervention. Factors associated with bradycardia were identified in a univariate analysis. A step-wise backward multiple logistic regression model was used to identify independent factors. Differences between the 2 groups were computed using Fisher's exact test or χ(2) tests for categorical data and t tests for continuous data.
  
  
  RESULTS
  Univariate analysis demonstrated that Down syndrome, low ASA physical status, congenital heart disease, and mean sevoflurane concentrations were factors associated with bradycardia. However, multivariate analysis showed that only Down syndrome and low ASA physical status remained as independent factors associated with bradycardia.
  
  
  CONCLUSIONS
  Bradycardia during anesthetic induction with sevoflurane was common in children with Down syndrome, with and without a history of congenital heart disease.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-4399, USA. kraemer@email.chop.edu
authors.forename: F Wickham
authors.initials: FW
authors.lastname: Kraemer
authors.forename: Paul A
authors.initials: PA
authors.lastname: Stricker
authors.forename: Harshad G
authors.initials: HG
authors.lastname: Gurnaney
authors.forename: Heather
authors.initials: H
authors.lastname: McClung
authors.forename: Marcie R
authors.initials: MR
authors.lastname: Meador
authors.forename: Emily
authors.initials: E
authors.lastname: Sussman
authors.forename: Beverly J
authors.initials: BJ
authors.lastname: Burgess
authors.forename: Brian
authors.initials: B
authors.lastname: Ciampa
authors.forename: Jared
authors.initials: J
authors.lastname: Mendelsohn
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Rehman
authors.forename: Mehernoor F
authors.initials: MF
authors.lastname: Watcha
mesh_terms: D000293:Adolescent; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects; D001919:Bradycardia / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004314:Down Syndrome / Q000150:complications*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006776:Hospitals, Pediatric; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D015994:Incidence; D007223:Infant; D016015:Logistic Models; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage / Q000009:adverse effects*; D015143:Philadelphia; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane