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.
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