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.