Original Article| Volume 36, ISSUE 1, P195-199, January 2022

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Dosing of Opioid Medications During and After Pediatric Cardiac Surgery for Children With Down Syndrome

Published:August 14, 2021DOI:


      To determine whether children with Down syndrome (DS) receive higher doses of opioid medications compared with children without DS for repair of complete atrioventricular canal (CAVC).


      A retrospective chart review of children with and without DS who underwent primary repair of CAVC. The exclusion criteria included unbalanced CAVC and patients undergoing biventricular staging procedures. The primary outcome was oral morphine equivalents (OME) received in the first 24 hours after surgery. The secondary outcomes included intraoperative OME, OME at 48 and 72 hours, nonopioid analgesic and sedative medications received, pain scores, time to extubation, and length of stay.


      A pediatric academic medical center in the United States.


      One hundred thirty-one patients with DS and 24 without, all <two years old, who underwent a CAVC repair.


      Not applicable.

      Measurements and Main Results

      Patients with DS were older than patients without DS (median 96.3 days [interquartile range {IQR} 70.7-128.2] v 75.9 days [IQR 49.8-107.3], p = 0.033) but otherwise not statistically different in the baseline characteristics. There was no difference in OME received in the first 24 hours postoperatively between groups (3.01 mg/kg [IQR 1.23-5.43] v 3.57 mg/kg [IQR 1.54-7.06], p = 0.202). OME at 48 and 72 hours was lower in the DS group compared with the control group. Similar amounts of opioid and non-opioid analgesics and sedatives were otherwise given to both groups of patients. Median pain scores did not differ between groups.


      These results suggested that patients with DS undergoing CAVC repair do not have increased opioid requirements compared with a similar control group.

      Key Words

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      Linked Article

      • Do Children With Down Syndrome Require More Opioids During Cardiac Surgery?
        Journal of Cardiothoracic and Vascular AnesthesiaVol. 36Issue 1
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          THE ASSOCIATION between Down syndrome (DS) and congenital heart disease (CHD) is well- documented, with many of these patients requiring surgical intervention in early childhood.1 Although DS does not convey an increased risk of mortality after congenital heart surgery, children with DS have an increased risk for postoperative complications, including increased length of stay (LOS), heart block requiring permanent pacemaker placement after ventricular septal defect (VSD) repair, respiratory complications, and complications related to pulmonary hypertension.
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