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Tenuous airway in children with trisomy 21
A L de Jong1, M Sulek, M Nihill
1Department of Otolaryngology, Baylor College of Medicine and Texas Children's Hospital, Houston 77030, U.S.A.
The Laryngoscope
|March 1, 1997
Summary
Postextubation stridor is common in children with Down syndrome (trisomy 21) undergoing heart surgery. Airway management requires special considerations to prevent complications like subglottic stenosis.
Area of Science:
- Pediatric Cardiology
- Anesthesiology
- Genetics
Background:
- Down syndrome (trisomy 21) is associated with congenital anomalies, particularly cardiac malformations requiring surgery.
- Postextubation stridor is an underrecognized complication in these patients following cardiovascular procedures.
Purpose of the Study:
- To determine the incidence of postextubation stridor in children with Down syndrome undergoing cardiovascular surgery.
- To identify risk factors associated with stridor development and subglottic stenosis.
Main Methods:
- Retrospective review of 99 patients with trisomy 21 who underwent cardiovascular surgery.
- Analysis of patient demographics, surgical factors, and airway complications, including stridor and subglottic stenosis.
Main Results:
- Postextubation stridor occurred in 24.2% of patients.
- Younger age, lower weight percentile, and reintubation were significant risk factors for stridor.
- Subglottic stenosis was identified in 6.1% of patients, often associated with oversized endotracheal tubes and low weight percentiles.
Conclusions:
- Children with Down syndrome undergoing cardiovascular surgery have a high incidence of postextubation stridor.
- Modified intubation techniques and careful airway management are crucial for this population to minimize airway morbidity.