Sevoflurane and bradycardia in infants with trisomy 21: A case report and review of the literature

Int J Pediatr Otorhinolaryngol. 2016 Jan:80:5-7. doi: 10.1016/j.ijporl.2015.11.007. Epub 2015 Nov 24.


Various perioperative concerns have been reported in patients with trisomy 21 including associated congenital heart disease, atlantoaxial instability, tracheal and subglottic stenosis, a predisposition to respiratory complications, hypothyroidism, and macroglossia leading to sleep disordered breathing. The recent literature has also suggested a propensity for the development of significant bradycardia during inhalation induction with sevoflurane. We present a 2-year-old girl with trisomy 21 who developed the rapid onset of bradycardia during anesthetic induction with sevoflurane. Previous reports are reviewed, postulated mechanisms discussed, and preventative strategies presented.

Keywords: Bradycardia; Sevoflurane; Trisomy 21.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Anesthetics, Inhalation / adverse effects*
  • Bradycardia / chemically induced*
  • Bradycardia / genetics
  • Child, Preschool
  • Down Syndrome / complications*
  • Female
  • Humans
  • Methyl Ethers / adverse effects*
  • Sevoflurane


  • Anesthetics, Inhalation
  • Methyl Ethers
  • Sevoflurane