Abstract
Down’s Syndrome (Trisomy 21, T21) occurs in approximately 0.15 percent of live births. In addition to the stigmata of the syndrome, other congenital defects are frequently found in these patients. Cardiac lesions are particularly prominent.
To determine the complications associated with anaesthesia and surgery we examined the records of 100 consecutive patients (58 males, 42 females) who underwent surgery with general anaesthesia during a two year period, from March 1978-March 1980.
In addition to the cardiac lesions, the low birth weight of Trisomy 21 infants, increased suceptibility to infections, atlanto-occipital dislocation, and reduced central nervous system catecholamine levels might be expected to result in an increased incidence of complications.
This study of 100 patients with Trisomy 21 (T21) indicates that the incidence of complications is low. However, the anaesthetist must understand the pathophysiology of T21 in order to provide optimal anaesthetic care.
Résumé
Le syndrome de Down ou Trisomie 21 survient environ dans 0.15 pour cent des cas de naissances vivantes. En plus des stigmates caractéYistiques du syndrome, on retrouve fréquemment chez ces patients d’autres lésions congénitales en particulier des malforma-tions cardiaques. Parmi les autres pathologies fréiquemment retrouvées chez eux et susceptibles d’éiever l’incidence des complications anesthésiques et chirurgicales chez ces patients, on retiendra leur tendance à être petits à la naissance (20 pour cent d’entre eux pèsent moins de 2500 gm), la susceptibilité accrue à l’infection, la laxité ligamentaire excessive importante à reconnaître surtout au niveau du cou (la luxation atlanto-occipitale peut survenir chez 12 pour cent des cas de trisomie 21) et les bas niveaux de catécholamines au niveau du système nerveux central.
Nous avons revisé les dossiers de 100 cas consécutifs de patients porteurs du syndrome opérés sous anesthésie générale entre les mois de mars 1978 et mars 1980, ceci dans le but d’établir l’incidence des complications chirurgicales et anesthésiques. Cette incidence s est avérée basse dans notre série.
II est important que 1’anesthésiste comprenne bien la physiopathologie de ces malades s’il veut leur fournir des soins de qualité.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Nelson, W.E., Vaughan, V.C. &McKay, R.J. (Eds.). Textbook of Pediatrics. 11th ed. Philadelphia: Saunders (1979), p. 352.
Carter, C.O. A life-table for mongols with the causes of death. J. Ment. Defic. Res.2. 64 (1958).
Fabia, J. &Drolette, M. Life tables up to age of 10 for mongols with and without congenital heart defect. J. Ment. Defic. Res.14: 235 (1970).
Chen,A.T.L., Sergovich,F.R., McKim,J.S., Barr, M.L. &Gruber, D. Studies in full-term, low-birth weight, mentally retarded patients. J. Pediatr.76: 393 (1970).
Greenwood, R.D. &Nadas, A.S. The clinical course of cardiac disease in Down’s syndrome. Pediatrics58: 893 (1976).
Chi, T.L. &Krovetz, L.J. The pulmonary vascular bed in children with Down syndrome. J. Pediatr.86: 533 (1975).
Wilson, S.K., Hutchins, G.M. &Neill, C.A. Hypertensive pulmonary vascular disease in Down syndrome. J. Pediatr.95: 722 (1979).
Rosengart, R.M. &Isabel-Jones, J.B. Pulmonary vascular involvement in Down syndrome. J. Pediatr.88: 161 (1976).
Clark, R.W., Schmidt, H.S. &Schuller, D.E. Sleep-induced ventilatory dysfunction in Down’s syndrome. Arch. Intern. Med.140: 45 (1980).
Katlic, M.R., Clarke, E.B., Neill, C., &Haller, J.A. Surgical management of congenital heart disease in Down’s syndrome. J. Thorac. Cardiovasc. Surg.74: 204 (1977).
Feingold, M. down’s syndrome and heart surgery. Pediatrics61: 331 (1978).
Downing, J.W. Jr.,Kaplan, S. &Bove, K.E. Postsurgical left anterior hemiblock and right bundle-branch block. Br. Heart J.34: 263 (1972).
Scott, J.G. &Allan, D. Anaesthesia for dentistry in children: a review of 101 surgical procedures. Can. Anaes. Soc. J.17: 391 (1970).
Kaplan, S. The adolescent with operated or unoperated congenital heart disease. Postgrad. Med.56: 147 (1974).
Ablin, R.J. Immunity in Down’s syndrome. Eur. J. Pediatr.127: 149 (1978).
Sutnick, A.I., London, W.T., Blumberg, S. &Gerstley, B.J.S. Anicteric hepatitis with Australia antigen in patients with Down’s syndrome. Am. J. Clin. Pathol.57: 2 (1972).
Levin, S., Schlesinger, M., Handzel, Z., Hahn, T., Altman, Y., Czernobilsky, Boss, J. Thymic deficiency in Down’s syndrome. Pediatrics63: 80 (1979).
Semine, A.A., Ertel, A.N., Goldberg, M.J. &Bull, M.J. Cervicalspine instability in children with Down syndrome (trisomy 21). J. Bone and Joint Surg.60-A: 649 (1978).
Hodgkinson, R. Anesthetic management of a parturient with severe juvenile rheumatoid arthritis. Anes. Analg. (Cleve.)60: 611 (1981).
Whaley, W.J. &Gray, W.D. Atlantoaxial dislocation and Down’s syndrome. Can. Med. Assoc. J.123: 35 (1980).
Lappalainen, J. &Louvalainen, K. High hematocrits in newborns with Down’s syndrome. Clin. Pediatr. (Phila.)11: 472 (1972).
Kohne, E. &KLEIHAUER, E. Beziehungen zwischen Polyglobulie und Hamglobinmuster bei Neugeborenen mit G Trisomie. Klin. Wochen-schr.55: 111 (1975).
Baxter, R.G., Larkins, R.G., Martin, F.I.R., Heyma, P., Myles, P., &Ryan, L. Down syndrome and thyroid function in adults. Lancet2: 794 (1975).
Berg, J.M., Brandon, M.W.G. &Kirman, B.H. Atropine in mongolism. Lancet2: 441 (1959).
Harris, W.S. &Goodman, R.M. Hyper-reactivity to atropine in Down’s syndrome. N. Eng. J. Med.279: 407 (1968).
Mir, G.H. &Cumming, G.R. Response to atropine in Down’s syndrome. Arch. Dis. Child.46: 61 (1971).
Keele, D.K., Richards, C., Brown, J. &Marshall, J. Catecholamine metabolism in Down’s syndrome. Am. J. Ment. Defic.74: 125 (1969).
Steward, D.J. Congenital abnormalities as a possible factor in the aetiology of post-intubation subglottic stenosis. Can. Anaes. Soc. J.17: 388 (1970).
Eger, E.I., II, Mac.InEger, E.I., II (Ed.) Anesthetic Uptake and Action. Baltimore: Williams & Wilkins (1974), p. 17.
Coleman, M., Campbell, M., Freedman, L.S., Roffman, M., Ebstein, R.P. &Goldstein, M. Serum dopamine-(3-hydroxylase levels in Down’s syndrome. Clin. Genet.5: 312 (1974).
Murdochs J.C., Rodger, J.C., Rao, S.S., Fletcher, C.D. &Dunnigan, M.G. Down’s syndrome: an atheroma-free model? Br. Med. J.2: 226 (1977).
Richards, B.W. &Enver, F. Blood pressure in Down’s syndrome. J. Ment. Defic. Res.23: 123 (1979).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kobel, M., Creighton, R.E. & Steward, D.J. Anaesthetic considerations in down’s syndrome: experience with 100 patients and a review of the literature. Canad. Anaesth. Soc. J. 29, 593–599 (1982). https://doi.org/10.1007/BF03007747
Issue Date:
DOI: https://doi.org/10.1007/BF03007747