{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:17:55Z","timestamp":1787015875643,"version":"build-2736575974"},"reference-count":14,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,2,24]],"date-time":"2021-02-24T00:00:00Z","timestamp":1614124800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Several prior studies have demonstrated an association between trisomy 21 and airway\u2010related anesthetic complications. However, there is a paucity of large clinical studies characterizing the airway challenges associated with trisomy 21. In this analysis, we examine anesthetic\u2010related airway complications in children with trisomy 21 and compare our findings to well\u2010matched controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A chart review of all general anesthetics occurring between 2011 and 2017 at a single pediatric hospital was performed. Children with trisomy 21 were identified. Matched controls were created using a 1:1 propensity score and controlling for patient sex, patient age, surgical specialty, airway management, and anesthetic induction technique. The primary outcomes were the numbers of difficult intubations and perioperative respiratory adverse events. Secondary outcomes included the number of intubation attempts and the Cormack\u2010Lehane grade in each cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results\/Data analysis<\/jats:title>\n                    <jats:p>\n                      A total of 2702 anesthetic records were reviewed. Propensity score matching resulted in adequately matched control groups as indicated by a standard mean difference below 0.2 in each case. Logistic regression analysis between trisomy 21 patients and matched controls demonstrated that the trisomy 21 cohort had a higher incidence of perioperative respiratory adverse events (OR 2.04, 95% CI 1.34\u20133.09,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.0008) due largely to a higher incidence of airway obstruction (1.7% vs. 0.2%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.0005). The trisomy 21 group had a lower rate of difficult intubation (OR 0.26, 95% CI 0.07\u20130.91,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.034). There was no association between trisomy 21 and the number of intubation attempts (RR 0.99, 95% CI 0.88\u20131.13,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.92) or Cormack\u2010Lehane grade (RR 0.95, 95% CI 0.87\u20131.05,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.35).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The trisomy 21 cohort had an increased incidence of perioperative respiratory adverse events compared to matched controls, largely secondary to a higher rate of obstructed ventilation, but without statistically different rates of laryngospasm, bronchospasm, postextubation stridor, or other desaturation events. Our trisomy 21 cohort had a decreased incidence of difficult intubation. There was no association between trisomy 21 and number of attempts required to successfully place an endotracheal tube or a less favorable CL grade.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Compared to matched controls, children with trisomy 21 have a lower incidence of difficult intubation and a higher incidence of perioperative respiratory adverse events, largely due to increased rate of airway obstruction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pan.14138","type":"journal-article","created":{"date-parts":[[2021,1,23]],"date-time":"2021-01-23T04:51:16Z","timestamp":1611377476000},"page":"410-418","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["An assessment of perioperative respiratory adverse events and difficult intubation in pediatric patients with Trisomy 21"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2583-7109","authenticated-orcid":false,"given":"Taylor J.","family":"Graber","sequence":"first","affiliation":[{"name":"Department of Anesthesiology University of California San Diego CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7372-4080","authenticated-orcid":false,"given":"Paola Lopomo","family":"Baskin","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology University of California San Diego CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Soria","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology University of California San Diego CA USA"},{"name":"Rady Children\u2019s Hospital San Diego San Diego CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Greenberg","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology University of California San Diego CA USA"},{"name":"Rady Children\u2019s Hospital San Diego San Diego CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4443-0021","authenticated-orcid":false,"given":"Rodney A.","family":"Gabriel","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology University of California San Diego CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alyssa","family":"Brzenski","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology University of California San Diego CA USA"},{"name":"Rady Children\u2019s Hospital San Diego San Diego CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,2,24]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.38402"},{"key":"e_1_2_10_3_1","volume-title":"Textbook of Pediatrics","author":"Behrman RE","year":"2019"},{"key":"e_1_2_10_4_1","first-page":"1223","volume-title":"The metabolic and molecular bases of inherited disease","author":"Epstein CJ","year":"2001"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2015.11.027"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2004.01329.x"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.36903"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2014.02.006"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.80.4.555"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.12561"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03007747"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpedi.152.2.119"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-199703000-00013"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2012.03813.x"},{"issue":"5","key":"e_1_2_10_15_1","first-page":"412","article-title":"Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe. Lancet","volume":"5","author":"Habre W","year":"2017","journal-title":"Respir Med"}],"container-title":["Pediatric Anesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pan.14138","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pan.14138","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pan.14138","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T22:19:42Z","timestamp":1693347582000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pan.14138"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,24]]},"references-count":14,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2021,4]]}},"alternative-id":["10.1111\/pan.14138"],"URL":"https:\/\/doi.org\/10.1111\/pan.14138","archive":["Portico"],"relation":{},"ISSN":["1155-5645","1460-9592"],"issn-type":[{"value":"1155-5645","type":"print"},{"value":"1460-9592","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,24]]},"assertion":[{"value":"2020-05-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-01-13","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-02-24","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}