Objective
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).
Design
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.
Setting
A pediatric academic medical center in the United States.
Participants
One hundred thirty-one patients with DS and 24 without, all <two years old, who underwent
a CAVC repair.
Interventions
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.
Conclusions
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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Article info
Publication history
Published online: August 14, 2021
Identification
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- Do Children With Down Syndrome Require More Opioids During Cardiac Surgery?Journal of Cardiothoracic and Vascular AnesthesiaVol. 36Issue 1
- PreviewTHE 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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