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Antoniazzi AM, Unda SR, Khatri D, Holland R, de la Garza Ramos R, Haranhalli N, Altschul DJ. Arterial Ischemic Stroke in Moyamoya patients that underwent Vaginal Delivery and Cesarean. World Neurosurg 2022; 163:e391-e395. [DOI: 10.1016/j.wneu.2022.03.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/27/2022] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
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Spinal Versus General Anesthesia for Cesarean Delivery in Pregnant Women With Moyamoya Disease: A Retrospective Observational Study. Anesth Analg 2022; 135:617-624. [PMID: 35089266 DOI: 10.1213/ane.0000000000005919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Moyamoya disease, a rare chronic cerebrovascular disease with a fragile vascular network at the base of the brain, can cause ischemic or hemorrhagic strokes or seizures. Precise blood pressure control and adequate analgesia are important for patients with moyamoya disease to prevent neurological events such as ischemia and hemorrhage. This study aimed to compare the intraoperative mean arterial pressure of pregnant women with moyamoya disease according to the mode of anesthesia (general anesthesia versus spinal anesthesia) used during cesarean delivery. METHODS We retrospectively reviewed the medical records of 87 cesarean deliveries in 74 patients who had been diagnosed with moyamoya disease before cesarean delivery. The primary outcome, intraoperative maximum mean arterial pressure during anesthesia, was compared according to the type of anesthesia administered (general versus spinal anesthesia). Other perioperative hemodynamic data (lowest mean arterial pressure, incidence of hypotension, vasopressor use, and antihypertensive agent use), maternal neurologic symptoms, neonatal outcomes (Apgar scores <7, ventilatory support, and intensive care unit admission), maternal and neonatal length of stay, postoperative pain scores, and rescue analgesic use were assessed as secondary outcomes. RESULTS While the lowest blood pressure during anesthesia and incidence of hypotension did not differ between the 2 groups, the maximum mean arterial pressure during anesthesia was lower in the spinal anesthesia group than that in the general anesthesia group (104.8 ± 2.5 vs 122.0 ± 4.6; P = .002). Study data did not support the claim that maternal neurologic symptoms differ according to the type of anesthesia used (5.6% vs 9.3%; P = .628); all patients recovered without any sequelae. The postoperative pain scores were lower, and fewer rescue analgesics were used in the spinal anesthesia group than in the general anesthesia group. Other maternal and neonatal outcomes were not different between the 2 groups. CONCLUSIONS Compared with general anesthesia, spinal anesthesia mitigated the maximum arterial blood pressure during cesarean delivery and improved postoperative pain in patients with moyamoya disease.
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Successful Regional Anesthetic for a Parturient with Moyamoya Syndrome. Case Rep Anesthesiol 2020; 2020:1785041. [PMID: 32231801 PMCID: PMC7085866 DOI: 10.1155/2020/1785041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/07/2020] [Indexed: 11/18/2022] Open
Abstract
Anesthesia for Cesarean section could be challenging due to the physiological changes during pregnancy, but it can be more complicated if associated with sickle cell disease and moyamoya disease. The moyamoya syndrome is nothing but sickle cell disease complicated by cerebral vasculopathy. Incidence of moyamoya disease in the USA is 0.086/100,000 people. We report a case of a pregnant woman with sickle cell disease and moyamoya syndrome, who underwent a successful spinal epidural for primary cesarean section, with careful monitoring of blood pressure.
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Fluss R, Ligas BA, Chan AW, Ellis JA, Ortiz RA, Langer DJ, Rahme R. Moyamoya-Related Stroke Risk During Pregnancy: An Evidence-Based Reappraisal. World Neurosurg 2019; 129:e582-e585. [PMID: 31176061 DOI: 10.1016/j.wneu.2019.05.225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/27/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Moyamoya is a rare, yet classic etiology of stroke in young adults, affecting predominately women of childbearing age. The impact of pregnancy on the natural history of symptomatic moyamoya remains a matter of extensive debate, however. METHODS In October 2017, a MEDLINE search was performed using 14 keywords. A total of 12 original articles reporting on cohorts of at least 5 patients were retrieved and reviewed. Individual study data were extracted, pooled, and analyzed. RESULTS A total of 736 pregnancies in 483 patients were included in our analysis. The mean age at delivery was 31 years, and the mean age at diagnosis (before pregnancy) was 22.6 years. Clinical presentation was ischemic stroke in 50.8%, hemorrhagic stroke in 45.9%, headaches in 2.1%, and ischemic-hemorrhagic stroke in 1.2%. After excluding patients first diagnosed during or after pregnancy (n = 283) and those who had been revascularized before pregnancy (n = 183), a total of 270 pregnancies in 188 patients were analyzed. During 224.6 patient-years of follow-up, 22 moyamoya-related neurologic events occurred (annual event rate 9.8%), more than two-thirds of which were transient (12 transient ischemic attacks and 3 seizures). Seven strokes occurred (6 hemorrhagic and 1 ischemic), yielding an annual stroke risk of 3.1%. As a result, 1 patient died and 2 were permanently disabled (annual death/disability rate 1.3%). All remaining patients experienced favorable functional outcomes. CONCLUSIONS The risk of moyamoya-related stroke during pregnancy, delivery, and the postpartum period appears to be similar to or lower than that suggested by published natural history studies in symptomatic patients. A neuroprotective effect of pregnancy in moyamoya patients cannot be excluded.
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Affiliation(s)
- Rose Fluss
- Division of Neurosurgery, SBH Health System, Bronx, New York, USA; Albert Einstein College of Medicine, Bronx, New York, USA
| | - Barbara A Ligas
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Amber W Chan
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Jason A Ellis
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Rafael A Ortiz
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - David J Langer
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Ralph Rahme
- Division of Neurosurgery, SBH Health System, Bronx, New York, USA; Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA; CUNY School of Medicine, New York, New York, USA.
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Inayama Y, Kondoh E, Chigusa Y, Io S, Funaki T, Matsumura N, Miyamoto S, Mandai M. Moyamoya Disease in Pregnancy: A 20-Year Single-Center Experience and Literature Review. World Neurosurg 2018; 122:684-691.e2. [PMID: 30347298 DOI: 10.1016/j.wneu.2018.10.071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Pregnancy is a potential risk factor for stroke in women with Moyamoya disease. However, the rarity of the disease has limited clinical expertise to ensure a healthy pregnancy. The aim of the present study was to explore the possible risk factors for hemorrhagic and ischemic stroke in pregnant women with Moyamoya disease. METHODS A retrospective review of cases in our hospital during a 20-year period and a review of the reported data were conducted to investigate pregnancy-related cerebrovascular events in women with Moyamoya disease. RESULTS Thirty pregnancies in 20 women with Moyamoya disease were identified in the case review of our hospital. All were previously diagnosed cases, and no stroke had occurred during the study period. In the reported data review, pregnancy-related stroke in women with Moyamoya disease was identified in 54 (44 intracranial hemorrhage and 10 cerebral infarction). Intracranial hemorrhage occurred most commonly during the antepartum period (n = 39; 88.6%), with most events occurring at ≥24 weeks. Of the intracranial hemorrhage cases, 7 (15.9%) were complicated by hypertensive disorders of pregnancy, and 8 patients (18.2%) died of stroke. The onset of cerebral infarction was either in the antepartum (n = 4; 40.0%) or postpartum (n = 6; 60.0%) period. All postpartum cases occurred within 3-7 days after delivery. CONCLUSION Pregnancy-related stroke in patients with Moyamoya disease might be susceptible to gestational age. Intracranial hemorrhage is prone to occur during the antepartum period, especially at ≥24 weeks, and cerebral infarction tends to occur postpartum.
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Affiliation(s)
- Yoshihide Inayama
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Eiji Kondoh
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Yoshitsugu Chigusa
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shingo Io
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Funaki
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Noriomi Matsumura
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Weston E, Mehta N. Moyamoya disease in pregnancy and delivery planning: A case series and literature review. Obstet Med 2016; 9:177-180. [PMID: 27829881 DOI: 10.1177/1753495x16653548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 05/07/2016] [Indexed: 11/17/2022] Open
Abstract
Moyamoya disease is a rare condition characterized by stenosis or occlusion of the intracranial internal carotid arteries leading to the development of fragile collateral vessels. Disruption of these vessels can lead to both ischemic and hemorrhagic strokes. As such, these patients are sensitive to changes in intracranial pressure and pose a challenge in pregnancy and delivery planning. Two cases of a parturients with moyamoya disease are presented, and the literature regarding safe method of delivery in similar patients is reviewed. The available evidence suggests that adequate anesthesia, and maintenance of hemodynamic status, takes precedence over the exact method of delivery in these patients. Cesarean delivery under epidural anesthesia can be a safe option for parturients with moyamoya disease, but an uncomplicated vaginal delivery, most often assisted with either vacuum or forceps, has also been frequently reported.
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Affiliation(s)
- Erica Weston
- Department of Obstetrics and Gynecology, Women and Infants Hospital, Rhode Island, USA
| | - Niharika Mehta
- Department of Medicine, Women and Infants Hospital, Rhode Island, USA
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Sato K, Yamada M, Okutomi T, Kato R, Unno N, Fujii K, Kumabe T. Vaginal Delivery under Epidural Analgesia in Pregnant Women with a Diagnosis of Moyamoya Disease. J Stroke Cerebrovasc Dis 2015; 24:921-4. [PMID: 25804571 DOI: 10.1016/j.jstrokecerebrovasdis.2014.11.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 11/25/2014] [Accepted: 11/28/2014] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Moyamoya disease more commonly occurs in young people and women, so patients with this disease may experience pregnancy and delivery. Cesarean section (CS) is often chosen as the mode of delivery for these patients in Japan. No appropriate mode of delivery has yet been established for pregnant women with moyamoya disease in terms of stroke prevention. We have used vaginal delivery under epidural analgesia (EA) in such patients unless CS has been indicated for the maternal or fetal reasons. This study retrospectively analyzed our patients with moyamoya disease who gave birth to confirm the safety of vaginal delivery under EA. METHODS Twelve consecutive patients diagnosed with moyamoya disease had 14 deliveries at our hospital between September 2004 and January 2013. The incidences of intrapartum stroke were compared between cases of vaginal delivery under EA and CS cases. RESULTS Ten vaginal deliveries under EA and 4 elective CSs were performed. No intrapartum stroke was observed during either vaginal delivery under EA or CS. Among the patients who underwent vaginal delivery under EA, 1 parturient who experienced 2 deliveries suffered transient ischemic attack during both postpartum periods. All 14 infants were healthy without sequelae. CONCLUSIONS Vaginal delivery under EA is an option for patients with moyamoya disease, provided that close cooperation with neurosurgeons, obstetricians, and anesthesiologists is assured.
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Affiliation(s)
- Kimitoshi Sato
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
| | - Masaru Yamada
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Toshiyuki Okutomi
- Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Rie Kato
- Division of Anesthesiology & Reanimatology for Paturients/Fetuses/Infants Research & Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Nobuya Unno
- Department of Obstetrics, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Kiyotaka Fujii
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Toshihiro Kumabe
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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Abstract
Abstract
Parturients with intracranial lesions are often assumed to have increased intracranial pressure, even in the absence of clinical and radiographic signs. The risk of herniation after an inadvertent dural puncture is frequently cited as a contraindication to neuraxial anesthesia. This article reviews the relevant literature on the use of neuraxial anesthesia in parturients with known intracranial pathology, and proposes a framework and recommendations for assessing risk of neurologic deterioration, with epidural analgesia or anesthesia, or planned or inadvertent dural puncture. The authors illustrate these concepts with numerous case examples and provide guidance for the practicing anesthesiologist in determining the safety of neuraxial anesthesia.
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Ray BR, Baidya DK, Gregory DM, Sunder R. Intraoperative neurological event during cesarean section under spinal anesthesia with fentanyl and bupivacaine: Case report and review of literature. J Anaesthesiol Clin Pharmacol 2012; 28:374-7. [PMID: 22869950 PMCID: PMC3409953 DOI: 10.4103/0970-9185.98349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Neurological events similar to transient ischemic attack in a peripartum woman are uncommon. Cerebral complications of preeclampsia, thrombo-embolic phenomena, or high spinal can mimic such situations. Spinal anesthesia with local anesthetic and opioid is an established anesthetic technique for cesarean section. Although intrathecal opioids are safe for both the mother and fetus; some unusual complications such as dysphagia alone or associated with facial numbness, aphasia, have been reported. We report a case of transient aphonia and tingling sensation over the face without any dysphagia after intrathecal administration of bupivacaine and fentanyl for cesarean section.
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Affiliation(s)
- Bikash Ranjan Ray
- Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi, India
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Fukushima K, Yumoto Y, Kondo Y, Fujita Y, Morokuma S, Tsukimori K, Wake N. A retrospective chart review of the perinatal period in 22 pregnancies of 16 women with Moyamoya disease. J Clin Neurosci 2012; 19:1358-62. [PMID: 22917762 DOI: 10.1016/j.jocn.2011.12.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 12/04/2011] [Accepted: 12/18/2011] [Indexed: 10/28/2022]
Abstract
Moyamoya disease (MMD) is characterized by severe stenoses of the arteries in the circle of Willis, which predispose the patient to brain ischemia and intracranial hemorrhage. We performed a retrospective chart review of 22 pregnancies in 16 patients with MMD at the Kyushu University Hospital. An uncomplicated Cesarean delivery was performed in nearly all patients. In the 20 pregnancies in patients with pre-existing MMD, two had transient ischemic symptoms in the postpartum period. Two patients not previously known to have MMD developed transient ischemic symptoms postpartum. One of these patients was initially diagnosed and managed as pre-eclampsia. For patients diagnosed with MMD, a good perinatal outcome can be expected with appropriate management. Neurological events, however, may still occur postpartum even in well-managed patients. MMD may mimic the signs and symptoms of other neurological or psychiatric disorders, thereby complicating diagnosis and management.
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Affiliation(s)
- Kotaro Fukushima
- Comprehensive Maternity and Perinatal Care Unit, Department of Obstetrics and Gynecology, Kyushu University Hospital, Kyushu University, Fukuoka, Japan.
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Moyamoya disease in pregnancy: management after intracranial bypass grafting. Case Rep Obstet Gynecol 2012; 2012:638471. [PMID: 22570803 PMCID: PMC3335491 DOI: 10.1155/2012/638471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 01/19/2012] [Indexed: 11/27/2022] Open
Abstract
Moyamoya disease (MD) is a chronic, progressive cerebrovascular disease distinguished by bilateral stenosis or occlusion of the arteries around the circle of Willis with resulting prominent arterial collateral circulation. We describe a pregnant woman in whom this diagnosis was confirmed by cerebral angiogram and treated with bilateral superficial temporal artery-middle cerebral artery (STA-MCA) bypass grafting prior to conception. The patient was managed with strict blood pressure monitoring and low-dose aspirin antepartum, intrapartum, and postpartum. The patient presented in spontaneous labor at term and underwent a spontaneous vaginal delivery without complications.
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Barrett HL, Lust K, Fagermo N, Callaway LK, Minuzzo L. Moyamoya disease in pregnancy: maintenance of maternal blood pressure. Obstet Med 2012; 5:32-4. [PMID: 27579131 DOI: 10.1258/om.2011.110046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2011] [Indexed: 11/18/2022] Open
Abstract
Moyamoya disease is a rare cerebrovascular occlusive disorder characterized by stenosis in the circle of Willis with the development of a compensatory circulation. It has been associated with significant morbidity in pregnancy including intracranial haemorrhage, ischaemic stroke and epilepsy. We present the case of a 26-year-old woman with a previous diagnosis of moyamoya vasculopathy with bilateral superficial temporal to middle cerebral artery bypass grafting. During the second trimester, she developed significant neurological symptoms related to postural hypotension in the presence of a stenosis of the right-sided graft. The hypotension was treated with fludrocortisone therapy with improvement in blood pressure and symptoms. Moyamoya vasculopathy poses unique challenges to obstetric care. This is the first report of use of fludrocortisone for maintenance of blood pressure during pregnancy in this condition.
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Affiliation(s)
- Helen L Barrett
- University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia, 4029; University of Queensland, School of Medicine, North, Herston, Queensland, Australia, 4029; Obstetric Medicine, Internal Medicine and Aged Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia, 4029
| | - Karin Lust
- University of Queensland, School of Medicine, North, Herston, Queensland, Australia, 4029; Obstetric Medicine, Internal Medicine and Aged Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia, 4029
| | - Narelle Fagermo
- University of Queensland, School of Medicine, North, Herston, Queensland, Australia, 4029; Obstetric Medicine, Internal Medicine and Aged Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia, 4029
| | - Leonie K Callaway
- University of Queensland, School of Medicine, North, Herston, Queensland, Australia, 4029; Obstetric Medicine, Internal Medicine and Aged Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia, 4029
| | - Lee Minuzzo
- Maternity Services, Royal Brisbane and Women's Hospital , Herston, Queensland , Australia , 4029
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Yalcin S, Cece H, Nacar H, Karahan MA. Axillary brachial plexus blockade in moyamoya disease? Indian J Anaesth 2011; 55:160-2. [PMID: 21712873 PMCID: PMC3106389 DOI: 10.4103/0019-5049.79897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Moyamoya disease is characterized by steno-occlusive changes of the intracranial internal carotid arteries. Cerebral blood flow and metabolism are strictly impaired. The goal in perioperative anaesthetic management is to preserve the stability between oxygen supply and demand in the brain. Peripheral nerve blockade allows excellent neurological status monitoring and maintains haemodynamic stability which is very important in this patient group. Herein, we present an axillary brachial plexus blockade in a moyamoya patient operated for radius fracture.
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Affiliation(s)
- Saban Yalcin
- Department of Anesthesiology, Reanimation, Harran University Medical Faculty, Şanliurfa, Turkey
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Shim KS, Kim EJ, Lee JH, Lee SG, Ban JS, Min BW. Combined spinal-epidural anesthesia for cesarean section in a patient with Moyamoya disease -A case report-. Korean J Anesthesiol 2010; 59 Suppl:S150-3. [PMID: 21286427 PMCID: PMC3030023 DOI: 10.4097/kjae.2010.59.s.s150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 04/23/2010] [Accepted: 05/09/2010] [Indexed: 11/10/2022] Open
Abstract
Moyamoya disease is a rare progressive occlusive disease of the internal carotid arteries. We report a case of combined spinal-epidural anesthesia in a patient with Moyamoya disease presenting for Cesarean section. Hypotension associated with spinal anesthesia for Cesarean section is the most common and serious adverse effect despite the use of uterine displacement and volume preload. We continuously infused phenylephrine and ephedrine to prevent hypotension. The intraoperative hemodynamic state was stable. The patient had no significant postoperative complications.
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Affiliation(s)
- Kwang Suk Shim
- Department of Anesthesiology and Pain Medicine, Fatima Hospital, Daegu, Korea
| | - Eun Ju Kim
- Department of Anesthesiology and Pain Medicine, Fatima Hospital, Daegu, Korea
| | - Ji Hyang Lee
- Department of Anesthesiology and Pain Medicine, Fatima Hospital, Daegu, Korea
| | - Sang Gon Lee
- Department of Anesthesiology and Pain Medicine, Fatima Hospital, Daegu, Korea
| | - Jong Seouk Ban
- Department of Anesthesiology and Pain Medicine, Fatima Hospital, Daegu, Korea
| | - Byung Woo Min
- Department of Anesthesiology and Pain Medicine, Fatima Hospital, Daegu, Korea
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Conn JJ, Champion De Crespigny PJ, Davis SM, Laidlaw JD, Moriarty K, Jurcevic PA. Successful pregnancy outcome in a patient with moyamoya disease. Aust N Z J Obstet Gynaecol 2009; 48:608-9. [PMID: 19133054 DOI: 10.1111/j.1479-828x.2008.00917.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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