TENUOUS AIRWAY IN CHILDREN WITH TRISOMY-21

Multiple congenital anomalies are closely linked to Down syndrome (tri somy 21). Cardiac malformations are found in 40% of patients, a large number of whom will require a major surgical procedure. The importance of postextubation strider in these children is frequently underestima ted. A retrospective review of 99 trisomy 21 patients who underwent ca rdiovascular surgery revealed postextubation strider in 24 (24.2%), Si gnificant factors for the development of strider included younger age (P=0.04), lower growth percentile for weight (P=0.03), and increased f requency of reintubation (P=0.04), Subglottic stenosis was found in 6 (6.1%). In 4 of these patients, an endotracheal tube of larger diamete r than predicted for age was used. All 6 patients were less than the 1 0th percentile for weight. We conclude that Down syndrome patients des erve special considerations and modifications of standard intubation t echniques for successful airway management.