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Hemodynamic volatility in children and young adults with down syndrome during procedural sedation
Justin Abe1, Panteha Hayati Rezvan2, Benjamin N Vogel3
1John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii.
Insights
Individuals with Down syndrome (DS) experience greater blood pressure drops during procedural sedation. This highlights potential risks for reduced cerebral blood flow in this population.
Area of Science:
- Anesthesiology
- Pediatrics
- Genetics
Background:
- Individuals with Down syndrome (DS) may have lower baseline blood pressure.
- Procedural sedation involves administering medications to induce a state of reduced consciousness.
- Understanding hemodynamic changes during sedation in DS is crucial for patient safety.
Purpose of the Study:
- To compare hemodynamic parameters during procedural sedation in children and young adults with and without Down syndrome.
- To evaluate blood pressure and pulse pressure changes from baseline to nadir during sedation.
Main Methods:
- Retrospective observational study comparing 150 patients with DS and 146 age-matched controls.
- Analysis of demographics, comorbidities, and preprocedural, median procedural, and nadir systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP).
- Examination of the rate of change in SBP and DBP from baseline to nadir.
Main Results:
- Baseline blood pressure and pulse pressure were similar between groups.
- Patients with DS had significantly lower median and nadir procedural SBP, DBP, and PP.
- The reduction in SBP and DBP from baseline to nadir was significantly larger in the DS group.
Conclusions:
- Children and young adults with DS demonstrate more pronounced blood pressure decreases during procedural sedation.
- Further research is needed to determine the clinical implications, such as potential impacts on cerebral blood flow.
- These findings underscore the importance of careful hemodynamic monitoring in DS patients undergoing sedation.
Objective:
Individuals with Down syndrome (DS) have been reported to have lower systemic blood pressure compared to individuals without DS. This study sought to retrospectively evaluate biomedical parameters in patients with DS undergoing procedural sedation compared to non-DS controls.
Methods:
A retrospective observational study was performed comparing children and young adults with DS ( n = 150) and age-matched non-DS patients ( n = 146) who underwent procedural sedation. Demographics, comorbidities, and diagnostic studies were assessed, along with preprocedural baseline, median procedural, and procedural nadir systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP). The average rate of change in SBP and DBP from baseline to nadir was also examined between the two groups.
Results:
Although baseline SBP, DBP, and PP were comparable between the two groups, individuals with DS showed lower median procedural SBP and DBP ( P < 0.001) as well as lower procedural nadir SBP, DBP, and PP ( P < 0.001). Consistent results were found for median SBP ( P = 0.006) and nadir SBP ( P = 0.006) percentiles. Notably, the reduction from baseline to nadir during sedation was larger in individuals with DS for both SBP (mean difference [95% CI]: -12.3 [-16.1, -8.6]) and DBP (-10.2 [-13.3, -7.0]) compared to the non-DS controls. These differences remained consistent even after adjusting for demographic factors.
Conclusions:
Children and young adults with DS exhibited significantly larger blood pressure drops during procedural sedation. Additional research is warranted to investigate the clinical significance of these findings, including the potential for decreased cerebral blood flow in this population during sedation.
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