Although some procedures are possible using local anaesthesia and / or sedation, given the added difficulty of communication and understanding, it is likely that patients with Down's Syndrome will be given a general anaesthetic even for these.

Whether a general anaesthetic is required for heart surgery or another operation the same principles apply.  When anaesthetising anyone with Down's Syndrome the anaesthetist needs to be aware of concerns regarding atlanto-axial instability (an increase in mobility in the top of the spine which is found in some people with Down's Syndrome) and also the possibility of a narrow oesophagus which may make intubation (insertion of the tube into the windpipe which is used to provide oxygen during the operation) more awkward.  If the patient has an unoperated heart condition and the operation is not cardiac related it may well be suggested that the surgery is undertaken at the heart unit where everything is on hand to deal with any potential problems. In some people with Down's Syndrome, anaesthesia is not safe because of high lung artery pressure (pulmonary hypertension).

Before surgery

Whatever the operation, the anaesthetist will visit on the ward before surgery, ask questions about the patients' health and medication, and explain what the anaesthetic will involve. They will have discussed the operation with the surgeon and use this information and what you tell them to decide on the best type of anaesthetic to use. They may prescribe some medicine to be taken just before going to the operating theatre, which is called a pre-med (pre-medication) that may include a sedative to make the patient relaxed and sleepy.

For a child, the nurse will put some local anaesthetic cream on the backs of their hands, so that it doesn't hurt when the cannula is put in in the anaesthetic room. Anyone having a general anaesthetic  will not be allowed to eat or drink for several hours before the operation, to reduce the chance of them being sick during and after the operation - they will have a sign over their bed saying 'Nil by Mouth'.

In the anaesthetic room

This is a room adjoining the operating theatre, where patients are put to sleep. It is usually possible for a parent to stay with a child until they are asleep, and may well be possible with older people with Down's Syndrome if you ask.

Once in the room an anaesthetic assistant will attach leads to monitor heart rate and oxygen level during the operation - these just stick to the skin and do not hurt. The anaesthetist will insert a cannula (drip needle) through the skin into a vein in the hand or arm, through which the anaesthetic and any other medication can be given.

The patient may be asked to breathe some oxygen from a mask whilst the anaesthesia is injected into the cannula making them go quickly to sleep.  Alternatively they may be asked to breathe anaesthetic gas through a mask which will take a couple of minutes for them to drift off.  Once they are asleep anyone who went with them to theatre will be asked to leave.

Finally before going into the theatre, the anaesthetist will insert a plastic tube through the mouth into their windpipe to help them breathe during the operation. Once asleep the anaesthetist may also insert a central line and arterial line which are thin tubes or cannulae, often inserted through the groin or side of the neck, into a vein or artery. They allow monitoring of the blood pressure, and can also be used for giving medicines or fluids, and taking blood samples.   The patient will be kept asleep with anaesthetic gases and will also be given painkillers before they wake up.

In the operating theatre

During the operation the anaesthetist will closely observe the patient's heart and lung functions and other aspects of their general care, as well as controlling the anaesthetic. At the end of the operation the anaesthetist allows them to wake up gently, by which time they are usually in the recovery area, or stays with them until they get to Intensive Care if they will remain sedated as after open heart surgery.

After the operation

After the operation patients will wake up in the recovery room of the theatre suite for minor operations, or may be taken asleep to the Intensive Care Unit after major surgery (see Intensive Care Unit Topic Note). There will be a nurse looking after them and monitoring them while in the recovery room, until they are fully awake and safe to return to the ward.

The anaesthetist will prescribe painkillers, should they be needed, for when they get back to the ward. They may also be on a drip to provide fluid until they are eating and drinking again.

Things to think about