Gây tê mặt phẳng cơ dựng sống C7 hai bên phối hợp trong gây mê ở trẻ mắc hội chứng Down cho phẫu thuật cố định cột sống cổ C1 - C2 mất vững do tiêu mỏm nha: Báo cáo một trường hợp

Abstract

Children with Down syndrome and atlantoaxial (C1 - C2) instability represent a challenging population for the anesthesiologist, combining a potentially difficult airway, an unstable cervical spine and associated congenital heart disease. We describe the anesthetic management of a 5-year-old girl (15 kg) with Down syndrome and surgically repaired congenital heart disease (ventricular and atrial septal defects, patent ductus arteriosus; no residual shunt) who presented with C1 - C2 instability due to odontoid erosion causing cord compression and right-sided weakness (power 1/5). She underwent posterior C1 - C2 fixation, C1 posterior arch resection for decompression and bone grafting under general endotracheal anesthesia. The airway was secured with a video laryngoscope and a small-sized endotracheal tube while keeping the cervical spine neutral, with first-attempt intubation (Cormack - Lehane grade II). Anesthesia was maintained with propofol total intravenous anesthesia, and bilateral C7 erector spinae plane blocks (ESPB) under ultrasound guidance were used as part of a multimodal analgesic strategy. Hemodynamics remained stable, estimated blood loss was no more than 100mL with no transfusion, neuromuscular blockade was reversed with sugammadex, and the trachea was extubated in the operating room. During the first 24 postoperative hours, no analgesic was administered beyond the intravenous paracetamol given at the end of surgery, and the child was discharged on postoperative day 6 with right arm motor power recovered from 1/5 to 4/5. This case suggests that safe anesthesia for such children requires cervical-spine-protective airway management, blood pressure maintained within a range adequate for spinal cord perfusion, cardiorespiratory optimization and multimodal analgesia. Bilateral C7 erector spinae plane block is a promising analgesic adjunct for pediatric posterior cervical spine surgery; however, as this is a single case without a validated pain assessment tool, its efficacy cannot be established.