Cervical spine considerations when anesthetizing patients with Down syndrome.

DOWN syndrome (DS) is the most common chromosomal disorder, occurring in 1 of every 600–800 births. It is characterized by mental retardation, as well as craniofacial, upper airway, cardiovascular, and gastrointestinal anomalies. One manifestation of DS relevant to anesthesiologists is upper cervical spine instability produced by ligamentous laxity, skeletal anomalies, or both. This instability can result in neurologic impairment, including quadriplegia. However, there are no evidencebased practical guidelines to aid anesthesiologists in caring for these patients. The risk of spinal cord injury during anesthesia is unknown, as are the preoperative factors that might aid in accurately defining the risk in specific patients.