anesthetic alternatives are available for the child with Down syndrome
Premedication for this child may be necessary
to facili-tate the induction of anesthesia. Oral midazolam may be considered
for premedication. Intramuscular ketamine can be used quite successfully for
premedication in the child with Down syndrome. However, the use of ketamine
would not be considered an option in this particular patient, on account of his
seizure disorder. Parental presence during the induction of anesthesia has been
proven to be quite helpful. However, parental presence should not be viewed as
a substitute for premedication.
If the airway examination appears normal, then
either an inhalation or intravenous induction can be performed. General
anesthesia with an endotracheal tube or laryngeal mask airway (LMA) are good
options for this patient. Sedation with a propofol infusion may also be
considered. The choice of anesthetic technique for the child with Down syndrome
will involve similar decision-making as with any patient.