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.


(Abstract Text HTML)    (Download PDF)

19 replies
  1. tinyurl.com
    tinyurl.com says:

    Hello! This post could not be written any
    better! Reading through this post reminds me of my old room mate!
    He always kept talking about this. I will
    forward this article to him. Pretty sure he will have a good
    read. Thank you for sharing!

  2. Buy Cheap Proxy
    Buy Cheap Proxy says:

    Howdy! I know this is somewhat off topic but I was wondering which blog platform are you using for this website? I’m getting fed up of WordPress because I’ve had issues with hackers and I’m looking at alternatives for another platform. I would be awesome if you could point me in the direction of a good platform.

  3. fly ticket
    fly ticket says:

    This is really interesting, You are a very skilled blogger.
    I’ve joined your feed and look forward to seeking more
    of your great post. Also, I’ve shared your site in my social networks!

  4. search cheap flights
    search cheap flights says:

    Hey there! This is kind of off topic but I need some advice
    from an established blog. Is it hard to set up your own blog?

    I’m not very techincal but I can figure things out pretty quick.
    I’m thinking about making my own but I’m not sure where to begin. Do you have any
    points or suggestions? Cheers

  5. cheap air tickets
    cheap air tickets says:

    you are in reality a just right webmaster. The website loading speed is amazing.

    It seems that you’re doing any unique trick.
    Furthermore, The contents are masterwork. you’ve performed
    a fantastic job on this topic!

  6. cheap flights domestic
    cheap flights domestic says:

    Magnificent beat ! I wish to apprentice while you amend your web
    site, how could i subscribe for a blog web site? The account
    aided me a acceptable deal. I had been a little bit acquainted of this your broadcast provided bright clear concept

  7. gamefly
    gamefly says:

    Hello there, I think your web site may be having browser compatibility problems.
    Whenever I look at your web site in Safari, it looks fine however
    when opening in I.E., it has some overlapping issues.
    I merely wanted to give you a quick heads up! Apart from that, great blog!

  8. gamefly
    gamefly says:

    I’m really enjoying the design and layout of your website.
    It’s a very easy on the eyes which makes it much more enjoyable for me
    to come here and visit more often. Did you hire out a developer to create
    your theme? Superb work!

  9. tinyurl.com
    tinyurl.com says:

    My brother suggested I might like this web site. He was entirely right.
    This post actually made my day. You can not imagine just how much time I
    had spent for this information! Thanks!

  10. tinyurl.com
    tinyurl.com says:

    It’s in point of fact a great and helpful piece of info.

    I am happy that you shared this helpful information with us.

    Please stay us up to date like this. Thank you for sharing.

  11. http://tinyurl.com/y2kx88j5
    http://tinyurl.com/y2kx88j5 says:

    Its such as you read my thoughts! You appear to understand so
    much approximately this, like you wrote the ebook in it or something.
    I believe that you just can do with a few percent to force the
    message house a little bit, but other than that, that is wonderful blog.
    An excellent read. I will definitely be back.


Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply

Your email address will not be published. Required fields are marked *