042 - Hemodynamic Instability in Individuals with Down Syndrome During Procedure Sedation

Publication Number: 42.5313

Justin Abe, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, United States; Jonathan D. Santoro, Children's Hospital Los Angeles, Los Angeles, CA, United States; Saba Jafarpour, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; Panteha Hayati Rezvan, Children's Hospital Los Angeles, Los Angeles, CA, United States

Background: Due to the abundance of clinical comorbidities, individuals with Down syndrome (DS) require more frequent sedation for diagnostic testing and have a higher risk of post-sedation complications than other neurotypical individuals. Although individuals with DS have been established to have lower blood pressure profiles than neurotypical individuals, the effect on hemodynamic parameters during procedural sedation has not been extensively studied.

Objective: This study sought to retrospectively evaluate hemodynamic parameters in children with DS undergoing procedural sedation compared to neurotypical controls.

Design/Methods: A retrospective observational study was performed comparing children with DS (n=150) and age-matched neurotypical pediatric patients (n=146) who underwent sedation for a procedure. Demographics, comorbidities, and diagnostic studies were assessed, along with pre-procedural baseline, median procedural, and procedural nadir systolic blood pressure (SBP) and diastolic blood pressure (DSBP). The average rate of change in SBP and DSBP from baseline to nadir was also examined between the two groups.

Results: Individuals with DS had a slightly higher median age (p=0.01) and BMI (p=0.03) but a lower median height (p < 0.001) compared to the control group. Furthermore, those with DS were more likely to have autism (p < 0.001), thyroid disfunction (p < 0.001), and cardiac conditions (p < 0.001). Although baseline SBP and DSBP were comparable between the two groups, individuals with DS showed lower median procedural SBP and DSBP (p < 0.001) as well as lower procedural nadir SBP and DSBP (p < 0.001). Notably, the drop from baseline to nadir during sedation was larger individuals in DS for both SBP (mean difference [95% CI]: -12.3 [-16.1, -8.6]) and DSBP (-10.2 [-13.3, -7.0]) compared to the neurotypical controls. The significant differences in procedural SBP were consistent even after adjusting for demographic factors.

Conclusion(s): Children with DS exhibited significantly larger drops in blood pressure during procedural sedation. Additional research should be done to investigate the clinical significance of these findings, including the potential for decreased cerebral blood flow in this population during sedation.

Table 1. Demographic, comorbidities, and procedure characteristics by diagnosis.
Data are frequency (%) or median [25th, 75th percentiles]. *p < 0.05 (in bold font). DS: Down Syndrome.
The frequency and percentage of incomplete variables: Race/Ethnicity (n = 51, 17.23%); Active cardiac condition (n = 4, 5.26%); History of HTN (n = 2, 0.68%).

Table 2. Blood pressure comparison by diagnosis.
Data are frequency and percentage or median [25th, 75th percentiles]. *p < 0.05 (in bold font). DS: Down Syndrome.

Figure 1. Change in Systolic Blood Pressure (SBP, panel a) and Diastolic Blood Pressure (DSBP, panel b) during sedation between individuals with Down Syndrome (DS) and Neurotypical Controls