Opioid Sparing Anaesthetic Technique in Downs Syndrome Child with Congenital Heart Disease and Atlanto-Occipital Instability: A Case Report

Vol 3 | Issue 1 | January-June 2022 | Page 31-34 | Himaunshu V. Dongre, Sandeep M. Diwan, Ganesh P. Bhong, Parag K. Sancheti

DOI: 10.13107/ijra.2022.v03i01.052

Authors: Himaunshu V. Dongre [1], Sandeep M. Diwan [1], Ganesh P. Bhong [1], Parag K. Sancheti [2]

[1] Department of Anaesthesia, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
[2] Department of Orthopaedics, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.

Address of Correspondence
Dr. Himaunshu V. Dongre,
Department of Anaesthesia, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
E-mail: himaunshu.dongre@gmail.com


Downs syndrome, a common chromosomal abnormality is associated with hip and patellar instability and also atlanto-axial instability. Recurrent dislocation of the hip joint leads to potential disability requiring surgical intervention. Femoral varus derotation osteotomy and fixation is one of the procedures performed to stabilise the hip joint. (1) We report a case of Downs syndrome associated with congenital heart disease (CHD) and atlanto-axial instability which successfully underwent femoral varus derotation osteotomy procedure.
Keywords: Downs Syndrome, Atlanto-axial instability


1. Knight DM, Alves C, Wedge JH. Femoral varus derotation osteotomy for the treatment of habitual subluxation and dislocation of the pediatric hip in trisomy 21: a 10-year experience. J Pediatr Orthop. 2011;31(6):638-43.
2. Foley C, Killeen OG. Musculoskeletal anomalies in children with Down syndrome: an observational study. Arch Dis Child. 2019;104(5):482-7.
3. Aly AS, Al-Kersh MA. Femoral and Dega osteotomies in the treatment of habitual hip dislocation in Down syndrome patients – is it efficient or not? J Child Orthop. 2018;12(3):227-31.
4. Jusabani MA, Rashid SM, Massawe HH, Howlett WP, Dekker MCJ. A case report of atlanto-axial instability in a Down Syndrome patient. Spinal Cord Ser Cases. 2018;4:106.
5. Meitzner MC, Skurnowicz JA. Anesthetic considerations for patients with Down syndrome. AANA J. 2005;73(2):103-7.
6. Bhattarai B, Kulkarni AH, Rao ST, Mairpadi A. Anesthetic consideration in downs syndrome–a review. Nepal Med Coll J. 2008;10(3):199-203.
7. Kayashima K, Yamasaki R. Selecting an Appropriate Cuffed Endotracheal Tube Using Ultrasound of the Cricoid in a Child with Down Syndrome. Turk J Anaesthesiol Reanim. 2018;46(4):323-5.
8. Benhaourech S, Drighil A, Hammiri AE. Congenital heart disease and Down syndrome: various aspects of a confirmed association. Cardiovasc J Afr. 2016;27(5):287-90.
9. Yuki K, Lee S, Staffa SJ, DiNardo JA. Induction techniques for pediatric patients with congenital heart disease undergoing non-cardiac procedures are influenced by cardiac functional status and residual lesion burden. J Clin Anesth. 2018;50:14-7.
10. Wiegele M, Marhofer P, Lönnqvist PA. Caudal epidural blocks in paediatric patients: a review and practical considerations. Br J Anaesth. 2019;122(4):509-17.
11. Jay MA, Thomas BM, Nandi R, Howard RF. Higher risk of opioid-induced respiratory depression in children with neurodevelopmental disability: a retrospective cohort study of 12 904 patients. Br J Anaesth. 2017;118(2):239-46.

How to Cite this Article: Dongre HV, Diwan SM, Bhong GP, Sancheti PK | Opioid Sparing Anaesthetic Technique in Downs Syndrome Child with Congenital Heart Disease and Atlanto-Occipital Instability: A Case Report | International Journal of Regional Anaesthesia | January-June 2022; 3(1): 31-34.


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