Postoperative Cardiorespiratory Arrest in Down Syndrome

A 24-year-old male with Down Syndrome (DS) presented with 1-day duration of right upper quadrant pain, nausea, and vomiting. He was timely diagnosed with acalculous cholecystitis and treated with laparoscopic cholecystectomy. His immediate postoperative period was complicated by acute onset bilateral pulmonary edema and subsequent respiratory failure which triggered a type II myocardial infarction. Patient’s course was further complicated with acute metabolic acidosis and acute kidney injury resulting in continuous veno-venous hemodialysis. Family members collectively decided to transition patient to comfort care. Over the next few hours the patient expired from cardiogenic shock as no further vasopressor support was administered.
It is well known that patients with DS rarely suffer from coronary artery disease. In this case, we believe the patient’s residual right ventricular dysfunction from a previous significant ventricular septal defect partially contributed to the patient’s decline. Furthermore, findings in previous reports describe general anesthesia and sevoflurate’s role in possibly inducing cardiac arrest due to autonomic dysfunction. Due to low cardiopulmonary reserves, DS patients are at higher risk of complications than the normal patient population. Considering many patients with DS either have existing or repaired structural anomaly, perioperative assessment and vigilant monitoring may help reduce cardiopulmonary complications in DS patients.