Which statement about anesthetic considerations in a patient with Down syndrome (trisomy 21) is most likely true?

Down syndrome (trisomy 21) is present in 0.1 percent of live births and is associated with several coexisting disorders that affect anesthetic management.

Approximately half of patients with trisomy 21 have hypothyroidism, and congenital heart disease is often present. Lesions common to these patients include tetralogy of Fallot (8 percent), patent ductus arteriosus (12 percent), ventricular septal defect (27 percent) and endocardial cushion defects (40 percent). Although usually asymptomatic, atlanto-occipital instability occurs in about one-sixth of the patients, and it is recommended that these patients be treated with precautions against instability.

Patients with trisomy 21 generally have a large tongue and seem to be more prone to airway obstruction. There is no association between trisomy 21 and mandibular hypoplasia.

Response to anesthetic...

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