Down’s syndrome

 

Airway &

C-spine

·      Big tongue

·      Small cavities

·      Narrow airway

·      Midface hypoplasia

·      Long, floppy, U-shaped epiglottis

->> Prefer IV induction: pre-med + topicalise skin

->> Use ETT two sizes too small for age

·      Atlanto-axial instability 10-30%

->> X ray screening before tonsillectomy

Breathing

·      OSA in 80%

->> Consider apnoea monitoring

->> Beware benzos and opioids

Circulation

·      Bradycardia common

·      Relatively rate-dependent cardiac output

->> Atropine drawn up

·      Congenital heart disease common (esp cushion defect)

·      Pulmonary hypertension common (multiple reasons)

·      Coronary artery disease

->> Consider pre-op TTE

Disability

·      Intellectual disability

·      Difficult to assess pain

->> Ask parents for assistance

->> Observe facial appearance, behaviour, vital signs

External

·      Obesity

·      Difficult IV access

·      Joint laxity

->> Care with positioning

Associated comorbidities

·      CVS: cushion defects, accelerated CAD, valve disease

·      Resp: OSA, PHTN

·      CNS: intellectual disability, early Alzheimer’s disease

·      GIT: TOF, duodenal atresia, Hirschprung’s

·      Haem: polycythaemia, immunodeficiency, leukaemia

·      Endo: hypothyroidism, coeliac

·      Musculosketal: atlanto-axial instability, joint laxity