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Down syndrome and the autonomic nervous system, an educational review for the anesthesiologist
Jamie W Sinton1, David S Cooper2, Susan Wiley3
1Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Insights
Children with Down syndrome (DS) often require surgery, presenting unique perioperative challenges. Understanding autonomic nervous system function in DS is crucial for optimizing pediatric anesthesia care.
Area of Science:
- Pediatric Anesthesiology
- Developmental Pediatrics
- Autonomic Neuroscience
Background:
- Down syndrome (DS) affects approximately 1 in 700 infants, characterized by cognitive impairment and congenital anomalies.
- Children with DS frequently undergo surgeries, necessitating specialized perioperative management.
- Common perioperative concerns include behavior, sedation, hypotonia, airway obstruction, venous access, and bradycardia.
Purpose of the Study:
- To highlight the significance of autonomic nervous system (ANS) dysfunction in pediatric patients with Down syndrome.
- To explore the potential link between ANS dysfunction and observed perioperative challenges in children with DS.
- To emphasize the importance of understanding ANS function for pediatric anesthesiologists.
Main Methods:
- Review of existing literature on autonomic nervous system function in adults and children with Down syndrome.
- Discussion of phenotypical features associated with perioperative challenges in DS.
- Exploration of the development and measurement of sympathetic and parasympathetic function.
Main Results:
- Autonomic nervous system dysfunction is a recognized comorbidity in adults with Down syndrome, potentially explaining perioperative issues.
- Phenotypical features of Down syndrome may be manifestations of underlying ANS dysfunction.
- Understanding ANS function is critical for addressing complex perioperative needs in pediatric DS patients.
Conclusions:
- Autonomic nervous system dysfunction is an underappreciated factor in the perioperative care of children with Down syndrome.
- Further research into ANS function in pediatric DS is warranted to improve anesthetic management.
- Pediatric anesthesiologists must consider ANS status when planning and executing perioperative care for these children.
Abstract:
Approximately one in every 700 babies in the United States is born with Down syndrome, or 0.14%. Children with Down syndrome have cognitive impairment and congenital malformations necessitating frequent occurrences of general anesthesia and surgery. The thoughtful perioperative care of children with Down syndrome is relevant and acutely complex for the pediatric anesthesiologist. Behavior, sedation, hypotonia, upper airway obstruction, venous access, and bradycardia are omnipresent concerns apart from the surgical pathology. Down syndrome is also associated with autonomic nervous system dysfunction, a comorbidity that is overlooked in discussions of perioperative care and is described thus far in adults. Autonomic nervous system function or dysfunction may explain the phenotypical features of the perioperative challenges listed above. For this reason, understanding the development and measurement of autonomic nervous system function is important for the pediatric anesthesiologist. Definition and quantification of sympathetic and parasympathetic function will be reviewed.