Abstract
BackgroundMost children with trisomy 13 display central apnea, and are prone to opioid-induced respiratory depression. We conducted opioid-free anesthesia for a patient with trisomy 13 and obstructive sleep apnea, and safely extubated the patient in the operating room.Case presentationA 27-month-old girl with trisomy 13 underwent tonsillectomy. Given her high sensitivity to opioids, general anesthesia was introduced and maintained only with 2–5% sevoflurane and 33% nitrous oxide in oxygen. We used acetaminophen for postoperative analgesia. The tracheal tube was removed under stable breathing pattern 10 min after the surgery in the operating room. Two years later, opioid-free anesthesia with 2–5% sevoflurane and 33% nitrous oxide in oxygen was again performed safely for tube insertion into both eardrums.ConclusionOpioid-free anesthesia with adequate non-narcotic analgesics is safe for children with trisomy 13 with multiple apnea-related comorbidities.
Highlights
Most children with trisomy 13 display central apnea, and are prone to opioid-induced respiratory depression
Opioid-free anesthesia with adequate non-narcotic analgesics is safe for children with trisomy 13 with multiple apnea-related comorbidities
We initially tried to maintain her Discussion Opioid-free anesthesia was safely performed for tonsillectomy in a child with trisomy 13 who presented with obstructive sleep apnea (OSA), which could cause opioid-induced respiratory depression
Summary
Opioid-free anesthesia is appropriate for patients who have high sensitivity to opioids. Opioid-free anesthesia that provides sufficient pain relief can be performed with multimodal analgesics in children with trisomy 13 and OSA, which causes chronic hypoxemia, or any other apnea-related comorbidities. Symptoms of obstructive sleep apnea, nasal obstruction, and enuresis in children with nonsyndromic cleft lip and palate: a prevalence study. Singh A: [Anesthesia in a child operated for cleft lip associated with Patau’s syndrome]. The anesthetic management for a patient with trisomy 13. Khetani JD, Madadi P, Sommer DD, Reddy D, Sistonen J, Ross CJ, et al Apnea and oxygen desaturations in children treated with opioids after adenotonsillectomy for obstructive sleep apnea syndrome: a prospective pilot study. Outcomes after adenotonsillectomy using a fixed anesthesia protocol in children with obstructive sleep apnea.
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