title: Preoperative evaluation and comprehensive risk assessment for children with Down syndrome.
abstract: Down syndrome is a common chromosome disorder affecting all body systems. This creates unique physiologic concerns that can affect safety during anesthesia and surgery. Little consensus exists, however, on the best way to evaluate children with Down syndrome in preparation for surgery. We review a number of salient topics affecting these children in the perioperative period, including cervical spine instability, cardiovascular abnormalities, pulmonary hypertension, upper airway obstruction, hematologic disturbances, prematurity, low birth weight, and the use of supplements and alternative therapies. Recommendations include obtaining a complete blood count to detect an increased risk for bleeding or stroke, and cardiology evaluation to identify patients with pulmonary hypertension, as well as undiagnosed or residual heart disease. Pediatric cardiac anesthesiologists and intensivists should be involved as needed. The potential for cervical spine instability should be considered, and the anesthesiologist may wish to have several options available both for the medications and equipment used. The child's family should always be asked if he or she is on any nutritional supplements, as some products marketed to families may have secondary effects such as inhibition of platelet function. Using this evaluation in presurgical planning will allow physicians to better consider the individual circumstances for their patients with Down syndrome. Our goal was to optimize patient safety by choosing the most appropriate setting and perioperative personnel, and to mitigate those risk factors amenable to intervention.
authors.affiliation: Division of Genetics & Metabolism, Children's National Health System, Washington, DC, USA.
authors.forename: Amy Feldman
authors.initials: AF
authors.lastname: Lewanda
authors.affiliation: Divisions of Anesthesiology, Sedation, and Perioperative Medicine, Children's National Health System, Washington, DC, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Matisoff
authors.affiliation: Division of Neonatology, Children's National Health System, Washington, DC, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Revenis
authors.affiliation: Division of Cardiology, Children's National Health System, Washington, DC, USA.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Harahsheh
authors.affiliation: Division of Critical Care Medicine, Children's National Health System, Washington, DC, USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Futterman
authors.affiliation: Divisions of Pulmonary Medicine and Sleep Medicine, Children's National Health System, Washington, DC, USA.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Nino
authors.affiliation: Divisions of Hematology and Oncology, Children's National Health System, Washington, DC, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Greenberg
authors.affiliation: Division of Neurosurgery, Children's National Health System, Washington, DC, USA.
authors.forename: John S
authors.initials: JS
authors.lastname: Myseros
authors.affiliation: Division of Genetics & Metabolism, Children's National Health System, Washington, DC, USA.
authors.forename: Kenneth N
authors.initials: KN
authors.lastname: Rosenbaum
authors.affiliation: Division of Genetics & Metabolism, Children's National Health System, Washington, DC, USA.
authors.forename: Marshall
authors.initials: M
authors.lastname: Summar
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004314:Down Syndrome / Q000150:complications* / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011300:Preoperative Care / Q000379:methods*; D018570:Risk Assessment; D055815:Young Adult
keywords: Down syndrome; anesthesia; perioperative; preoperative; surgery; trisomy 21