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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Preoperative evaluation and comprehensive risk assessment for children with Down syndrome
Amy Feldman Lewanda1, Andrew Matisoff2, Mary Revenis3
1Division of Genetics & Metabolism, Children's National Health System, Washington, DC, USA.
Insights
Children with Down syndrome (DS) have unique health considerations for anesthesia and surgery. Preoperative evaluation should address potential risks like cervical spine instability and cardiac issues to ensure patient safety.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Genetics
Background:
- Down syndrome (DS) is a common chromosomal disorder impacting multiple organ systems.
- Unique physiological concerns in DS patients pose risks during anesthesia and surgery.
- Limited consensus exists on optimal preoperative evaluation for pediatric DS patients.
Purpose of the Study:
- To review key perioperative considerations for children with Down syndrome.
- To provide recommendations for optimizing patient safety in the perioperative period.
- To guide presurgical planning for individualized patient care.
Main Methods:
- Review of salient topics affecting children with DS in the perioperative period.
- Inclusion of cervical spine instability, cardiovascular abnormalities, pulmonary hypertension, airway obstruction, hematologic disturbances, prematurity, low birth weight, and supplement use.
- Development of recommendations for preoperative evaluation and management.
Main Results:
- Complete blood count recommended to assess bleeding/stroke risk.
- Cardiology evaluation crucial for identifying pulmonary hypertension and heart disease.
- Consideration of cervical spine instability and anesthetic management options is advised.
- Inquiry about nutritional supplements is necessary due to potential medication interactions.
Conclusions:
- Comprehensive preoperative evaluation is essential for children with Down syndrome.
- Addressing specific physiological concerns can mitigate perioperative risks.
- Involving specialists like pediatric cardiac anesthesiologists and intensivists optimizes care.
- Individualized planning enhances patient safety and outcomes for DS patients undergoing surgery.
Abstract:
Down syndrome is a common chromosome disorder affecting all body systems. This creates unique physiologic concerns that can affect safety during anesthesia and surgery. Little consensus exists, however, on the best way to evaluate children with Down syndrome in preparation for surgery. We review a number of salient topics affecting these children in the perioperative period, including cervical spine instability, cardiovascular abnormalities, pulmonary hypertension, upper airway obstruction, hematologic disturbances, prematurity, low birth weight, and the use of supplements and alternative therapies. Recommendations include obtaining a complete blood count to detect an increased risk for bleeding or stroke, and cardiology evaluation to identify patients with pulmonary hypertension, as well as undiagnosed or residual heart disease. Pediatric cardiac anesthesiologists and intensivists should be involved as needed. The potential for cervical spine instability should be considered, and the anesthesiologist may wish to have several options available both for the medications and equipment used. The child's family should always be asked if he or she is on any nutritional supplements, as some products marketed to families may have secondary effects such as inhibition of platelet function. Using this evaluation in presurgical planning will allow physicians to better consider the individual circumstances for their patients with Down syndrome. Our goal was to optimize patient safety by choosing the most appropriate setting and perioperative personnel, and to mitigate those risk factors amenable to intervention.
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