Bradycardia during induction of anesthesia with sevoflurane in children with Down syndrome

Anesth Analg. 2010 Nov;111(5):1259-63. doi: 10.1213/ANE.0b013e3181f2eacf. Epub 2010 Aug 24.


Background: Bradycardia is a complication associated with inhaled induction of anesthesia with halothane in children with Down syndrome. Although bradycardia has been reported after anesthetic induction with sevoflurane in these children, the incidence is unknown.

Objectives: In this study we compared the incidence and characteristics of bradycardia after induction of anesthesia with sevoflurane in children with Down syndrome to healthy controls.

Methods: We reviewed electronic anesthetic records of 209 children with Down syndrome and 268 healthy control patients who had inhaled induction of anesthesia with sevoflurane over an 8-year period. Data extracted from the medical record included demographics, history of congenital heart disease, heart rate, oxyhemoglobin saturation, expired sevoflurane concentrations, arterial blood pressure, and any treatment of bradycardia during the first 360 seconds after the start of induction of anesthesia. Bradycardia and hypotension were defined as heart rate and arterial blood pressure below the critical limits recommended for activating a pediatric rapid response team to the bedside of a hospitalized child for quick intervention. Factors associated with bradycardia were identified in a univariate analysis. A step-wise backward multiple logistic regression model was used to identify independent factors. Differences between the 2 groups were computed using Fisher's exact test or χ(2) tests for categorical data and t tests for continuous data.

Results: Univariate analysis demonstrated that Down syndrome, low ASA physical status, congenital heart disease, and mean sevoflurane concentrations were factors associated with bradycardia. However, multivariate analysis showed that only Down syndrome and low ASA physical status remained as independent factors associated with bradycardia.

Conclusion: Bradycardia during anesthetic induction with sevoflurane was common in children with Down syndrome, with and without a history of congenital heart disease.

MeSH terms

  • Adolescent
  • Anesthetics, Inhalation / administration & dosage
  • Anesthetics, Inhalation / adverse effects*
  • Blood Pressure / drug effects
  • Bradycardia / chemically induced*
  • Bradycardia / epidemiology
  • Bradycardia / physiopathology
  • Case-Control Studies
  • Chi-Square Distribution
  • Child
  • Child, Preschool
  • Down Syndrome / complications*
  • Female
  • Heart Rate / drug effects
  • Hospitals, Pediatric
  • Humans
  • Hypotension / chemically induced
  • Incidence
  • Infant
  • Logistic Models
  • Male
  • Methyl Ethers / administration & dosage
  • Methyl Ethers / adverse effects*
  • Philadelphia
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Sevoflurane


  • Anesthetics, Inhalation
  • Methyl Ethers
  • Sevoflurane