Anesthetic management of a combative patient with down syndrome who did not undergo a preoperative examination

We experienced the anesthetic management of a patient with Down syndrome who did not undergo any preoperative examinations. A 18-year-old woman was scheduled for dental treatment. Her height was about 160 cm, and her weight was about 50 kg. We were unable to perform any physical examinations to evaluate characteristics such as possible cervical spine abnormalities, airway condition, or neurological changes, nor were we able to perform respiratory function tests, laboratory tests, electrocardiography, or thoracic X-ray examinations because the patient had mental retardation and was combative in unfamiliar places and when presented with unfamiliar devices. She had a physical activity level of 7 metabolic equivalents, and no findings suggested a difficult intubation. After the induction of anesthesia through the inhalation of 8% sevoflurane in oxygen while the patient was sitting in a wheelchair, we began monitoring the patient's blood pressure, electrocardiogram, and oxygen 'saturation level measured using a pulse oxymeter (SpO₂). We then administered fentanyl (100 μg) after moving her to a dental chair and obtaining peripheral intravenous access. Rocuronium (35 mg) was also administered intravenously to facilitate the tracheal intubation. We were able to perform a smooth intubation using a laryngoscope. The anesthesia was maintained with inhaled sevoflurane, air, and oxygen. We started the dental treatment after confirming that all the examinations were within the normal ranges. The surgery proceeded uneventfully. She regained consciousness from the anesthesia while in a bed, and her vital signs were stable.