Difficult intravenous (IV) access related to obesity and xerodermia (dry, thickened skin) can complicate delivery of anesthesia and pain medicines. Other conditions that must be considered when planning anesthesia and sedation include: autoimmune disorders (such as celiac disease and hypothyroidism), diabetes, dementia, depression, epilepsy, hypotonia, obesity, and osteoporosis. Some of these conditions occur at higher frequencies in people with Down syndrome, but most occur at similar rates compared to other populations. Some conditions people with Down syndrome are less likely to exhibit than people without Down syndrome include asthma, hypertension, coronary or peripheral vascular disease, and solid organ tumors.
Conditions affecting vision or hearing will further complicate communication problems that may already be present in people with Down syndrome. As noted earlier, such communication problems can contribute to anxiety, agitation, and behavioral issues in the surgical setting.
Anesthesia personnel will ask a lot of questions about the patient’s medical and surgical histories, some of which may be historically remote in occurrence. The key to understanding why anesthesia providers want so much information is knowing that many remote conditions (e.g. AAI/AOI, congenital heart disease, difficult intubation, rheumatic fever, or malignant hyperthermia) can lead to sequelae (consequences of injury or disease) – even apparently unsymptomatic sequelae – that directly affect anesthetic safety.
***
NDSS thanks special guest author James E. Hunt, M.D of Arkansas Children’s Hospital for this article. Special thanks also to Drs. Timothy Martin (MD, MBA, Professor, Chief of Pediatric Anesthesia and Pain Medicine, and Vice-Chair of UAMS Department of Anesthesiology) and Michael Schmitz (MD, Director of Pediatric CV Anesthesia for Arkansas Children’s Hospital, Professor in UAMS Departments of Anesthesiology and Pediatrics).