The majority of children with Down syndrome are friendly and separate from parents easily. The presence of comorbidities should be the area of focus for the anesthesiologist. Cardiac anomalies are commonly present, and the most common of these is common atrioventricular canal. Not all patients present with cardiac disease though, and some may present with gastrointestinal anomalies. These children also exhibit sensitivity to inhalational anesthetics resulting in bradycardia during inhalation induction. They tend to have very narrow auditory canals, making myringotomy challenging and resulting in relatively longer anesthetics for ear tube placement. Careful attention should be paid to positioning of the neck during instrumentation of the airway as well due to possible instability of the cervical spine.
