Down’s syndrome

Airway &

C-spine

· Big tongue

· Small cavities

· Narrow airway

· Midface hypoplasia

· Laryngomalacia / long, floppy, U-shaped epiglottis

· Atlanto-axial instability common 10-30%

· Reflux common

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

->> Prefer RSI

->> Use ETT two sizes too small for age

->> X ray screening before tonsillectomy

Breathing

· OSA in 80%

->> Consider apnoea monitoring

->> Beware benzos and opioids

Circulation

· Bradycardia common

· Relatively rate-dependent cardiac output

· Congenital heart disease common (esp cushion defect)

· Pulmonary hypertension common (multiple reasons)

· Coronary artery disease

->> Atropine drawn up

->> 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