TYK134

A 4 year-old boy with Down syndrome and obstructive sleep apnea presents for tonsillectomy and adenoidectomy. The child has not had cervical neck films. You perform a history and physical examination which reveals normal upper extremity strength and there is no clinical history of cervical myelopathy. How should you proceed?

a) Obtain STAT cervical flexion/extension radiographs prior to proceeding

b) Proceed with the case utilizing apneic fiberoptic intubation; direct laryngoscopy is contraindicated for this patient

c) Cancel the case until c-spine has been cleared

d) Proceed with general anesthesia and direct laryngoscopy, minimizing neck extension during airway management.

e) None of the above

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Answer

Answer d.

While cervical instability may be present in Down syndrome, only 1 to 2% of patients are symptomatic. Flexion/extension films are dependent on patient cooperation and are not necessarily predictive of risk for injury, particularly in young children such as this one. Thus, routine screening is not recommended for young children. While fiberoptic intubation is a reasonable choice, direct laryngoscopy is NOT contraindicated in this population.

Notes

This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.

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