Children with Down syndrome (DS) often experience dangerously low heart rates on induction of anesthesia for routine procedures and this occurs at 10 times the rate of non-DS patients. Given that the cardiac output of children is heart rate dependent, bradycardia is especially perilous in this population. Historically, individuals with DS were not expected to survive beyond childhood; consequently, correction of congenital anomalies, e.g. cardiac defects, was not frequently offered. Fortunately, today individuals with DS live into adulthood and surgical correction of anomalies is universally offered. Thus, increasing numbers of children with DS are exposed to anesthesia and at risk for this hemodynamic catastrophe. It is medically unacceptable and an autonomic nervous system mechanism will be sought.
Study Type
OBSERVATIONAL
Enrollment
195
Use of an Ambulatory Monitoring System from Vuije University (VU-AMS) to record autonomic and cardiovascular activity of patients undergoing otolaryngologic surgery with anesthesia. This monitoring device will provide data of ANS activity and normoxic bradycardia among patients with Down Syndrome. This data will be compared to data from patients without Down Syndrome.
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, United States
Ambulatory feasibility of VU-AMS monitor on patients with Down Syndrome
Subjects will be observed for monitor use coming to the hospital for surgery. The two outcomes will be binary: wearing the device or not. We anticipate that 50% of subjects will be wearing the VU-AMS monitor on entry to the hospital on the day of surgery.
Time frame: Immediately upon entry into Same Day Surgery patient room
Ambulatory feasibility of VU-AMS monitor on patients without Down Syndrome
Subjects will be observed for monitor use coming to the hospital for surgery. The two outcomes will be binary: wearing the device or not. We anticipate that 50% of subjects will be wearing the VU-AMS monitor on entry to the hospital on the day of surgery.
Time frame: Immediately upon entry into Same Day Surgery patient room
Operating room feasibility of VU-AMS monitor on patients with Down Syndrome
Subjects will be observed for monitor use throughout surgery. We anticipate that 80% of subjects will wear the VU-AMS in the operating room
Time frame: Immediately prior to mask induction with sevoflurane
Operating room feasibility of VU-AMS monitor on patients without Down Syndrome
Subjects will be observed for monitor use throughout surgery. We anticipate that 80% of subjects will wear the VU-AMS in the operating room
Time frame: Immediately prior to mask induction with sevoflurane
Autonomic data including pre-ejection period and respiratory sinus arrhythmia among patients with Down Syndrome
Among subjects who become bradycardic with induction of anesthesia, we expect that the pre-ejection period will increase by 20%
Time frame: Beginning at time of bradycardia and continuing for the next 300 seconds.
Autonomic data including pre-ejection period and respiratory sinus arrhythmia among patients without Down Syndrome
Among subjects who become bradycardic with induction of anesthesia, we expect that the pre-ejection period will increase by 20%
Time frame: Beginning at time of bradycardia and continuing for the next 300 seconds.
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