Finding the contribution of the autonomic nervous system during perioperative events in children with Down Syndrome

项目摘要/摘要 唐氏综合征(DS)儿童在麻醉诱导时经常经历危险的低心率 对于常规程序，这种情况的发生率是非DS患者的10倍。考虑到心脏的输出量 儿童心率依赖，心动过缓在这一人群中尤其危险。 从历史上看，患有DS的人预计不会活过童年；因此，纠正 先天性畸形，如心脏缺陷，并不常见。幸运的是，今天患有DS的人 活到成年，手术矫正畸形是普遍提供的。因此，越来越多的 患有DS的儿童暴露在麻醉下，并面临这种血液动力学灾难的风险。这是医学上的 不能接受，需要更多的研究。 本项目试图通过研究诱导性心动过缓的机制来解决这一问题。我们计划 量化这些心动过缓事件期间心率的神经系统决定因素，并最终形成 识别和缓解风险的协议。具体来说，我们的目标是： 1)使用多参数监测来量化诱导期间的自主神经系统行为 潜在地揭示了它们的根本原因。 2)测试自主神经系统监护仪使用门诊和围手术期的可行性 监测方案，以检测哪些患者处于危险之中。 该项目的成功完成将提供所需的生理信息，以降低 DS患儿麻醉诱导中的病态心动过缓事件。

PROJECT SUMMARY/ABSTRACT Children with Down syndrome (DS) often experience dangerously low heart rates on induction of anesthesia for routine procedures and this occurs at 10 times the rate of non-DS patients. Given that the cardiac output of children is heart rate dependent, bradycardia is especially perilous in this population. Historically, individuals with DS were not expected to survive beyond childhood; consequently, correction of congenital anomalies, e.g. cardiac defects, was not frequently offered. Fortunately, today individuals with DS live into adulthood and surgical correction of anomalies is universally offered. Thus, increasing numbers of children with DS are exposed to anesthesia and at risk for this hemodynamic catastrophe. It is medically unacceptable and requires more study. This project seeks to address the problem of induction bradycardia by studying its mechanism. We plan to quantify nervous system determinants of heart rate during these bradycardic events and eventually develop protocols to identify and mitigate the risk. Specifically, we aim to: 1) Quantify the autonomic nervous system behavior during induction using multi-parameter monitoring to potentially unveil their root cause. 2) Test the feasibility of that autonomic nervous system monitor using both ambulatory and perioperative monitoring protocols to detect which patients are at risk. Successful completion of this project will provide the physiologic information required to reduce the risk of morbid bradycardic events on induction of anesthesia in children with DS.