Abstract
Down's syndrome is the most commonly encountered congenital anomaly in medical practice. These patients are of special concern to medical practice because of their associated problems with regard to respiratory, cardiovascular and other systemic problems. As these patients present for repeated surgeries like dental extraction, facial reconstruction and fixation of cervical spine, these patients pose challenges to the anesthesiologist because of their unique set of problems, namely atlantoaxial instability, small trachea, congenital heart disease and repeated chest infections due to lowered immunity. Their reactivity to inhalational anesthetics and atropine is variable. Here we present an interesting case report of a child with Down's syndrome who presented with atlantoaxial instability for MRI of cervical spine under general anesthesia.
Highlights
Multiple problems associated with Down’s syndrome and involvement of various organ systems necessitates meticulous identification of these problems and careful handling of these children
We describe the management of a child of Down’s Syndrome having atlanto axial instability who presented to us for Magnetic resonance imaging (MRI) of the neck
The syndrome was first described by Dr John Langdon Down in 1866
Summary
Multiple problems associated with Down’s syndrome and involvement of various organ systems necessitates meticulous identification of these problems and careful handling of these children. Attention to airway management and positioning with minimal movements of the cervical spine is essential, keeping in view the relatively high incidence of atlanto-axial instability(AAI). The incidence of AAI is high in patients with Down’s syndrome, the reports of such complications and its management are very few in literature. Guidelines and recommendations in airway management and positioning during surgery for the patients are vague. We strongly feel the need to formulate evidence based guidelines and a cost effective preoperative screening tools to prevent cervical instability, since more Down’s Syndrome children are being referred for anesthesia in the past two decades. We describe the management of a child of Down’s Syndrome having atlanto axial instability who presented to us for Magnetic resonance imaging (MRI) of the neck
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