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Airway and Anesthesia Survey for Cornelia de Lange Syndrome

Instructions: For each question below, please select the best answer that describes your child or problem that has occurred.  Thank You

  1. Has your child ever received sedation or general anesthesia for a procedure or surgery? 
    A. If no, please scroll to the bottom of this page and submit, do not complete any more questions. 
  2. Are you the parent /guardian of a child with Cornelia de Lange Syndrome?  

    A. If no, please do not complete any more of the survey.  Scroll to the bottom of the survey and submit.
  3. How old is your child? 
  4. Which features of your child's anatomy have been identified as challenging for airway management? (select all that apply)
  5. Has your child experienced difficulty with breathing during sedation or general anesthesia?  

    A. If yes, was it due to:
    *If anatomical features mentioned in question #4, what kind of breathing problems did your child experience due to anatomical features in question #4?
  6. Has your child ever had a problem with sedation or anesthesia medicines used for a procedure? 
    A. If yes, please identify the medications and explain the specific problem(s) or reaction(s):

    B. What was the procedure during which your child had problems?
  7. Has your child had problems occur during dental procedures?

    A. If yes, please identify any specific problems occurring during dental procedures:

    B. What type of sedation or general anesthesia medicine(s) were used for these dental procedures? (or write "not sure")
  8. Has your child ever vomited and/or aspirated (the entry of stomach contents or food from the stomach to the windpipe) during a procedure or surgery? 


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