Hemodynamic volatility in children and young adults with down syndrome during procedural sedation.

Objective: Individuals with Down syndrome (DS) have been reported to have lower systemic blood pressure compared to individuals without DS. This study sought to retrospectively evaluate biomedical parameters in patients with DS undergoing procedural sedation compared to non-DS controls.

Methods: A retrospective observational study was performed comparing children and young adults with DS (n = 150) and age-matched non-DS patients (n = 146) who underwent procedural sedation. Demographics, comorbidities, and diagnostic studies were assessed, along with preprocedural baseline, median procedural, and procedural nadir systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP). The average rate of change in SBP and DBP from baseline to nadir was also examined between the two groups.

Results: Although baseline SBP, DBP, and PP were comparable between the two groups, individuals with DS showed lower median procedural SBP and DBP (P < 0.001) as well as lower procedural nadir SBP, DBP, and PP (P < 0.001). Consistent results were found for median SBP (P = 0.006) and nadir SBP (P = 0.006) percentiles. Notably, the reduction from baseline to nadir during sedation was larger in individuals with DS for both SBP (mean difference [95% CI]: -12.3 [-16.1, -8.6]) and DBP (-10.2 [-13.3, -7.0]) compared to the non-DS controls. These differences remained consistent even after adjusting for demographic factors.

Conclusions: Children and young adults with DS exhibited significantly larger blood pressure drops during procedural sedation. Additional research is warranted to investigate the clinical significance of these findings, including the potential for decreased cerebral blood flow in this population during sedation.