title: Sevoflurane and bradycardia in infants with trisomy 21: A case report and review of the literature.
abstract: Various perioperative concerns have been reported in patients with trisomy 21 including associated congenital heart disease, atlantoaxial instability, tracheal and subglottic stenosis, a predisposition to respiratory complications, hypothyroidism, and macroglossia leading to sleep disordered breathing. The recent literature has also suggested a propensity for the development of significant bradycardia during inhalation induction with sevoflurane. We present a 2-year-old girl with trisomy 21 who developed the rapid onset of bradycardia during anesthetic induction with sevoflurane. Previous reports are reviewed, postulated mechanisms discussed, and preventative strategies presented.
authors.affiliation: Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, United States. Electronic address: Hina.Walia@Nationwidechildrens.org.
authors.forename: Hina
authors.initials: H
authors.lastname: Walia
authors.affiliation: Department of Otolaryngology and Head & Neck Surgery, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, United States.
authors.forename: James
authors.initials: J
authors.lastname: Ruda
authors.affiliation: Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, United States; Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, United States; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
mesh_terms: D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D001919:Bradycardia / Q000139:chemically induced* / Q000235:genetics; D002675:Child, Preschool; D004314:Down Syndrome / Q000150:complications*; D005260:Female; D006801:Humans; D008738:Methyl Ethers / Q000009:adverse effects*; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane
keywords: Bradycardia; Sevoflurane; Trisomy 21