Frequency of anesthesia-related complications in children with Down syndrome under general anesthesia for noncardiac procedures

Background: Craniofacial and cardiac anomalies of Down syndrome (DS; trisomy 21) would seem to place these patients at higher risk of anesthesia-related complications (ARCs), but to date no comprehensive large-scale study has quantified this risk. Methods: A retrospective chart review was conducted on all patients with DS undergoing anesthesia between April 1, 1988, and May 31, 1995, at Children's Hospital of Pittsburgh. In addition, the Anesthesiology Department Quality Assurance (QA) System database of concurrently collected anesthesia information on all patients undergoing anesthesia at the hospital since 1985 was analyzed. Results: Of the total 74 021 anesthetic encounters during the study period, 930 anesthetic encounters in 488 patients with DS undergoing noncardiac procedures were analyzed. The most frequent ARCs were bradycardia (severe) (3.66%), natural airway obstruction (1.83%), difficult intubation (0.54%), postintubation croup (1.83%), and bronchospasm (0.43%). Conclusions: Comprehensive reporting is needed to capture all significant adverse events. The incidences of bradycardia on induction, natural airway obstruction, and postintubation (or instrumentation) croup were significantly higher in the DS noncardiac group compared with the remaining population. Current anesthesia techniques and agents must be compared using quantitative QA data to ensure use of the safest options for each patient.