Transient cardiac arrest in a child with Down syndrome during anesthesia induction with sevoflurane: a case report

This report describes a case of transient cardiac arrest in a child with Down syndrome. The cardiac arrest occurred during induction of anesthesia with sevoflurane. To the best of our knowledge, this is the first such report.

A 14-year-old boy was scheduled to undergo dental treatment under general anesthesia because of his mental disorder. He had congenital atrial and ventricular septal defects and patent ductus arteriosus, which had been repaired previously. Therefore, we anticipated no problems with his cardiovascular system during the perioperative period. Because the sedation administered before the insertion of an intravenous catheter and arterial line was insufficient to induce an anesthetic effect, general anesthesia was induced by using a mixture of sevoflurane (5 %) with oxygen in nitrous oxide. A few minutes after the induction of anesthesia, the patient unexpectedly experienced bradycardia (heart rate <30 beats/min), and his electrocardiography findings indicated asystole. After a few minutes of cardiopulmonary resuscitation, the patient's heart rate returned to normal.

We postulated that the asystole was triggered by a dysfunction in the autonomic cardiac regulation and sympathetic activation, which often occurs in patients with Down syndrome, and due to the use of high concentrations of sevoflurane. In future cases of pediatric patients with Down syndrome, with or without heart disease, the concentration of sevoflurane administered during surgery should be increased gradually. Moreover, an intravenous catheter should be promptly inserted to administer anticholinergic drugs as quickly as possible in order to prevent transient cardiac arrest.