A patient with trisomy 21 (Down's syndrome) may have a number of problems during anesthesia and surgery.


Conditions that may cause problems during intubation or while trying to maintain the airway:

(1) relative macroglossia

(2) micrognathia

(3) narrow hypopharynx

(4) muscular hypotonia

(5) occipitoatlantoaxial instability (with risk of spinal cord compression)

(6) subglottic stenosis

(7) midface hypoplasia with narrowing of the nasal passages


Conditions that may contribute to difficult vascular access:

(1) obesity

(2) xerodermia

(3) atopic dermatitis


Conditions that may cause problems during and after surgery:

(1) obstructive sleep apnea

(2) cardiac malformations

(3) pulmonary hypertension

(4) bradycardia


Specific risks that need to be avoided:

(1) dental injury

(2) postintubation stridor

(3) distress or agitation during induction or recovery

(4) postoperative infection, including subacute bacterial endocarditis

(5) increased sensitivity to atropine



(1) Perform a careful history and physical prior to surgery.

(2) Use of antibiotic prophylaxis prior to surgery.

(3) Monitor cardiopulmonary function during and after surgery.


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