Down’s syndrome: abnormalities

Patients with Down’s syndrome may have an airway complicated by both macroglossia, tonsillar/adenoidal hypertrophy, micrognathia, and a short neck. They may also have obstructive sleep apnea and lax cervical ligaments as well as other cervical abnormalities (ex. odontoid) leading to cervical instability (atlantooccipital instability in 9%). Children and adults may need down-sized endotracheal tubes. ~ 50% of these patients will have congenital heart disease, half of which are cushion defects (ex. AV canal), also ASD, VSD, tetralogy, and PDA. Those that have left-to-right shunts tend to develop pulmonary hypertension before patients without Down’s. Developmental delay is common.

Down’s Syndrome Abnormalities Relevant to the Anesthesiologist

• Airway: Macroglossia, tonsillar/adenoidal hypertrophy, micrognathia, short neck, OSA, cervical instability, small trachea
• Cardiac: Congenital heart disease (in 50%, most commonly endocardial cushion defects)
• Pulmonic: OSA, early development of pulmonary hypertension in L to R shunts
• Neuromuscular: Developmental delay, hypotonia