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Down syndrome with possible cardiac disease — FRCA Final MCQ

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ModeratePaediatricDown syndrome with possible cardiac diseaseFRCA Final

A 9-year-old child with Down syndrome is listed for adenotonsillectomy. He snores heavily, saturates 94% on air, has a systolic murmur and tires when walking uphill. No echocardiogram is available. What is the most appropriate management?

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Correct answer: B — Defer surgery for cardiology assessment including echocardiography

Down syndrome is associated with congenital heart disease and pulmonary hypertension, and the symptoms plus low saturation make significant pathology plausible. Elective adenotonsillectomy should be deferred for cardiology assessment rather than proceeding on the basis of ECG or antibiotic prophylaxis. Sedation does not reduce the underlying cardiopulmonary risk. This mirrors the Final FRCA style of integrating history, examination and anaesthetic planning.

Reference: RCoA GPAS paediatric anaesthesia 2022; APAGBI preassessment guidance