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Yang KJ, Mistry P, Ayrian E. Update on the anesthesia management in adult patients with moyamoya disease. Curr Opin Anaesthesiol 2024:00001503-990000000-00210. [PMID: 39011661 DOI: 10.1097/aco.0000000000001411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
PURPOSE OF REVIEW The anesthetic management of patients with Moyamoya disease (MMD) is challenging and continues to evolve. The goal of this review is to provide updated recommendations on the anesthetic management of adult MMD patients based on the relevant existing literature. RECENT FINDINGS Key findings include the importance of aggressive hydration preoperatively to sustain cerebral perfusion. Hypertension induced intraoperatively may prevent cerebral hypoperfusion. Vigilance against cerebral hyperperfusion after revascularization is necessary, with specific blood pressure targets recommended. Fluid management should aim for normovolemia to mild hypervolemia. Maintaining body temperature helps prevent cerebral vasospasm induced by hypothermia. Maintaining adequate oxygen supply during surgery is crucial. In cases of ischemic stroke, managing hematocrit and oxygen carrying capacity is essential to prevent further ischemia. Extubation decisions should consider baseline neurological function, while postoperative normocapnia helps prevent cerebral hyperperfusion and hypertension. In intensive care, cautious blood pressure management is crucial to prevent secondary complications. SUMMARY Strategies in the preoperative, intraoperative, and postoperative anesthetic management of MMD patients should aim to maintain adequate cerebral perfusion to prevent cerebral ischemia.
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Affiliation(s)
- Kevin J Yang
- Keck School of Medicine, University of Southern California, California, USA
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Plitman E, Venkatraghavan L, Agrawal S, Raghavan V, Chowdhury T, Sobczyk O, Sayin ES, Poublanc J, Duffin J, Mikulis D, Fisher J. Variability of Resting Carbon Dioxide Tension in Patients with Intracranial Steno-occlusive Disease. Asian J Neurosurg 2024; 19:235-241. [PMID: 38974441 PMCID: PMC11226286 DOI: 10.1055/s-0044-1786699] [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: 07/09/2024] Open
Abstract
Introduction Controlling the partial pressure of carbon dioxide (PaCO 2 ) is an important consideration in patients with intracranial steno-occlusive disease to avoid reductions in critical perfusion from vasoconstriction due to hypocapnia, or reductions in blood flow due to steal physiology during hypercapnia. However, the normal range for resting PCO 2 in this patient population is not known. Therefore, we investigated the variability in resting end-tidal PCO 2 (P ET CO 2 ) in patients with intracranial steno-occlusive disease and the impact of revascularization on resting P ET CO 2 in these patients. Setting and Design Tertiary care center, retrospective chart review Materials and Methods We collected resting P ET CO 2 values in adult patients with intracranial steno-occlusive disease who presented to our institution between January 2010 and June 2021. We also explored postrevascularization changes in resting P ET CO 2 in a subset of patients. Results Two hundred and twenty-seven patients were included [moyamoya vasculopathy ( n = 98) and intracranial atherosclerotic disease ( n = 129)]. In the whole cohort, mean ± standard deviation resting P ET CO 2 was 37.8 ± 3.9 mm Hg (range: 26-47). In patients with moyamoya vasculopathy and intracranial atherosclerotic disease, resting P ET CO 2 was 38.4 ± 3.6 mm Hg (range: 28-47) and 37.4 ± 4.1 mm Hg (range: 26-46), respectively. A trend was identified suggesting increasing resting P ET CO 2 after revascularization in patients with low preoperative resting P ET CO 2 (<38 mm Hg) and decreasing resting P ET CO 2 after revascularization in patients with high preoperative resting P ET CO 2 (>38 mm Hg). Conclusion This study demonstrates that resting P ET CO 2 in patients with intracranial steno-occlusive disease is highly variable. In some patients, there was a change in resting P ET CO 2 after a revascularization procedure.
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Affiliation(s)
- Eric Plitman
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Lashmi Venkatraghavan
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sanket Agrawal
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Vishvak Raghavan
- Department of Computer Science, Faculty of Science, McGill University, Montreal, Quebec, Canada
| | - Tumul Chowdhury
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Olivia Sobczyk
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ece Su Sayin
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - Julien Poublanc
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - James Duffin
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - David Mikulis
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, Canada
| | - Joseph Fisher
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Kaku Y, Ohmori Y, Kameno K, Uchikawa H, Takemoto Y, Kawano T, Ishimura T, Uetani H, Mukasa A. Inhalational Anesthesia Reduced Transient Neurological Events After Revascularization Surgery for Moyamoya Disease. Neurosurgery 2023:00006123-990000000-01002. [PMID: 38108408 DOI: 10.1227/neu.0000000000002804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/02/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The choice between inhalational and total intravenous anesthesia (TIVA) in revascularization surgery for Moyamoya disease (MMD) remains a topic of debate. Anesthesia methods have changed with the advent of new anesthetics. This study investigated whether modern anesthesia methods affected the development of neurological symptoms after revascularization surgery for MMD. METHODS This single-center retrospective study included 63 adult patients (82 hemispheres) with MMD treated with direct and indirect bypass surgeries at our hospital between 2013 and 2022. Patients were divided into inhalational anesthesia (IA) and TIVA groups based on the anesthesia maintenance method. Baseline patient characteristics; postoperative neurological symptoms, including hyperperfusion syndrome, cerebral infarction, and transient neurological events (TNEs); and cortical hyperintensity belt (CHB) sign scores (5-point scale from 0 to 4) on postoperative magnetic resonance imaging were compared between the two groups. The operation methods, anesthetics, and intraoperative hemodynamic and ventilatory parameters were compared between patients with and without TNEs. RESULTS The IA and TIVA groups comprised 39 and 43 hemispheres, respectively. The frequency of postoperative hyperperfusion syndrome and cerebral infarction did not differ between the groups, but the number of TNEs in the IA group (5/39; 13%) was significantly lower than that in the TIVA group (16/43; 37%). Multivariate logistic regression analysis revealed that TNEs were associated with TIVA (odds ratio, 3.91; 95% CI, 1.24-12.35; P = .02). The median [IQR] postoperative CHB sign score in the IA group (2 [1-3]) was significantly lower than that in the TIVA group (4 [3-4]). CONCLUSION The IA group had fewer postoperative TNEs and lower CHB sign scores than the TIVA group. Although further studies are needed, this study provides insights into the prevention of TNEs with IA and reconsideration of the optimal anesthesia for MMD.
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Affiliation(s)
- Yasuyuki Kaku
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Yuki Ohmori
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Koki Kameno
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Hiroki Uchikawa
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Yushin Takemoto
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Takayuki Kawano
- Department of Neurosurgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | | | - Hiroyuki Uetani
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Akitake Mukasa
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan
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Chan JL, Quintero-Consuegra MD, Babadjouni RM, Chang D, Barnard ZR, Martin NA, Ziv K, Van de Wiele BM, Gonzalez NR. Encephaloduroarteriosynangiosis Operative Technique and Intraoperative Anesthesia Management: Treatment From Both Sides of the Curtain. Oper Neurosurg (Hagerstown) 2022; 22:20-27. [PMID: 34982901 PMCID: PMC10602499 DOI: 10.1227/ons.0000000000000009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/08/2021] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Encephaloduroarteriosynangiosis (EDAS) is a form of indirect revascularization for cerebral arterial steno-occlusive disorders. EDAS has gained growing interest as a technique applicable to pediatric and adult populations for several types of ischemic cerebral steno-occlusive conditions. OBJECTIVE To present a team-oriented, multidisciplinary update of the EDAS technique for application in challenging adult cases of cerebrovascular stenosis/occlusion, successfully implemented in more than 200 cases. METHODS We describe and demonstrate step-by-step a multidisciplinary-modified EDAS technique, adapted to maintain uninterrupted intensive medical management of patients' stroke risk factors and anesthesia protocols to maintain strict hemodynamic control. RESULTS A total of 216 EDAS surgeries were performed in 164 adult patients, including 65 surgeries for patients with intracranial atherosclerotic disease and 151 operations in 99 patients with moyamoya disease. Five patients with intracranial atherosclerotic disease had recurrent strokes (3%), and there was one perioperative death. The mean clinical follow-up was 32.9 mo with a standard deviation of 31.1. There was one deviation from the surgical protocol. There were deviations from the anesthesia protocol in 3 patients (0.01%), which were promptly corrected and did not have any clinical impact on the patients' condition. CONCLUSION The EDAS protocol described here implements a team-oriented, multidisciplinary adaptation of the EDAS technique. This adaptation resides mainly in 3 points: (1) uninterrupted administration of intensive medical management, (2) strict hemodynamic control during anesthesia, and (3) meticulous standardized surgical technique.
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Affiliation(s)
- Julie L. Chan
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Robin M. Babadjouni
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Daniel Chang
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Zachary R. Barnard
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Neil A. Martin
- Department of Neurosurgery, Pacific Neuroscience Institute, Los Angeles, California, USA
| | - Keren Ziv
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Barbara M. Van de Wiele
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Nestor R. Gonzalez
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Song T, Liu X, Han R, Huang L, Zhang J, Xu H. Effects of end-tidal carbon dioxide levels in patients undergoing direct revascularization for Moyamoya disease and risk factors associated with postoperative complications. Medicine (Baltimore) 2021; 100:e24527. [PMID: 33607783 PMCID: PMC7899818 DOI: 10.1097/md.0000000000024527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 01/05/2021] [Indexed: 01/05/2023] Open
Abstract
A history of transient ischemic attack, severity of disease, urinary output, hematocrit, hypocapnia, and hypotension during direct revascularization (superficial temporal artery to middle cerebral artery [STA-MCA]) in patients with Moyamoya disease (MMD) may lead to a poor prognosis, however, to our knowledge evidence for end-tidal carbon dioxide (ETCO2) targets is lacking. Within the ranges of standardized treatment, the article was primarily designed to study the risk factors associated with the neurologic outcomes during STA-MCA for MMD especially including ETCO2 ranges and the duration in different groups. The primary goals of this study were to investigate the risk factors for neurologic deterioration and explore the association between ETCO2 ranges and neurologic outcome during general anesthesia for STA-MCA.This retrospective observational study included 56 consecutively adult Moyamoya patients who underwent STA-MCA under general anesthesia between January 2015 and August 2019. ETCO2 was summarized per patient every 5 minutes. Clinical outcome was assessed with clinical presentation, computed tomography findings, magnetic resonance imaging findings, cerebral angiography, and the modified Rankin Scale scores at discharge as main outcome measure. The outcomes were also compared for the duration of surgery, anesthesia, and the length of stay.A total of 56 patients were studied, all patients had comprehensive ETCO2 measurements. The incidence of postoperative complications was 44.6% (25/56). There was no association between age, sex, hypertension, diabetes, smoking history, drinking history, sevoflurane use, invasive arterial blood pressure monitoring, combined encephalomyosynangiosis and postoperative complications. Duration of surgery (P = .04), anesthesia (P = .036), hospital stay (P = .023) were significant correlates of postoperative complications. In the multiple logistic regression model, they were not the significant predictors. The ETCO2 ranges and the length of time in different groups within the current clinical setting was not associated with postoperative complications (P > .05).Within a standardized intraoperative treatment strategy, we found that postoperative complications had no significant correlation with sex, age, hypertension, diabetes, smoking history, drinking history, invasive arterial blood pressure monitoring, combined encephalomyosynangiosis, or sevoflurane use. Further, hypocapnia and hypercapnia during STA-MCA were not found to be associated with postoperative complications in patients with MMD.
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Affiliation(s)
- Tingting Song
- The First Hospital of Jilin University, Changchun, Jilin
| | - Xiancun Liu
- Linyi people's hospital, Linyi, Shandong, China
| | - Rui Han
- The First Hospital of Jilin University, Changchun, Jilin
| | - Lihua Huang
- The First Hospital of Jilin University, Changchun, Jilin
| | - Jingjing Zhang
- The First Hospital of Jilin University, Changchun, Jilin
| | - Haiyang Xu
- The First Hospital of Jilin University, Changchun, Jilin
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A Retrospective Study of Neurological Complications in Pediatric Patients With Moyamoya Disease Undergoing General Anesthesia. Anesth Analg 2021; 132:493-499. [PMID: 32149758 DOI: 10.1213/ane.0000000000004715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Moyamoya disease is a condition with potentially devastating and permanent neurological sequelae. Adequate volume status and blood pressure, tight control of carbon dioxide to achieve normocarbia, and providing postoperative analgesia to prevent hyperventilation are typical goals that are used during anesthetic care in these patients. The purpose of this study was to assess postanesthesia neurological complications in moyamoya patients undergoing general anesthesia for imaging studies and surgical procedures excluding neurosurgical revascularization. METHODS We performed a retrospective cohort study examining moyamoya patients who received general anesthesia for imaging studies and nonneurosurgical-revascularization procedures between January 1, 2001 and December 1, 2016 at our quaternary care pediatric hospital. A general anesthetic encounter was excluded if it occurred within 30 days after a revascularization surgery. The electronic medical records of study patients were analyzed for perioperative management, and neurological outcomes within 30 days of an anesthetic were assessed. RESULTS A total of 58 patients undergoing 351 anesthesia exposures were included in the study. Three patients experienced neurological complications, which included focal neurological weakness, seizure, and altered mental status. The incidence of complications during anesthesia encounters was 0.85% (3/351) with a 95% confidence interval of 0.28-2.62. CONCLUSIONS Over a 16-year period at our hospital, 3 children with moyamoya disease who underwent anesthesia for nonneurosurgical-revascularization purposes demonstrated postanesthesia neurological symptoms. The symptoms were consistent with transient ischemic attacks and all resolved without long-term sequelae.
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Giustini AJ, Stone SA, Ramamoorthy C. Moyamoya disease in children and its anesthetic implications: A review. Paediatr Anaesth 2020; 30:1191-1198. [PMID: 33463884 DOI: 10.1111/pan.14001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/05/2020] [Accepted: 08/11/2020] [Indexed: 02/06/2023]
Abstract
Moyamoya disease is a rare, progressive cerebral vasculopathy which most commonly presents in the first and fourth decades of life. The mainstay of treatment is surgical revascularization; without treatment, most patients experience ischemic or hemorrhagic strokes. This report reviews moyamoya disease, its associated conditions, surgical treatment techniques, and anesthetic management of patients with moyamoya disease.
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Affiliation(s)
- Andrew J Giustini
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, California, USA
| | - Sarah A Stone
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, California, USA
| | - Chandra Ramamoorthy
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, California, USA
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Kohara J, Dong L, Takeda C, Shiraki A, Fukagawa H, Mizota T. Derivation and validation of an equation to determine the optimal ventilator setting in children undergoing intracranial revascularization surgery: A single-center retrospective study. Paediatr Anaesth 2020; 30:50-56. [PMID: 31733085 DOI: 10.1111/pan.13764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/15/2019] [Accepted: 11/04/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND It can be difficult to determine the appropriate ventilator settings to maintain normocapnia in children undergoing general anesthesia for surgery for moyamoya disease, especially immediately following anesthesia induction. AIM We conducted this study to attempt to derive an equation to predict the appropriate ventilator settings and subsequently validated the accuracy of the equation. METHODS A retrospective study of 91 pediatric patients less than 18 years of age who underwent cerebral revascularization for moyamoya disease at our institution. Fifty-eight patients were used to derive the equation, and the subsequent 33 patients were used to validate the equation. We calculated the required respiratory rate to attain normocapnia based on the median of all values of the minute volume during normocapnia (estimated partial pressure of arterial carbon dioxide of 38-42 mm Hg) and the assumption that the tidal volume was 8 mL/kg body weight. We derived the regression equation from the derivation data set where the required respiratory rate to attain normocapnia was represented by age. We simplified the equation by rounding coefficients to the nearest integer. The level of agreement between the respiratory rate predicted from the equation and the actual required respiratory rate was assessed in the validation group using Bland-Altman analysis. RESULTS The derived equation is tidal volume = 8 mL/kg body weight, respiratory rate = 24-age/min. Bland-Altman analysis in the validation group revealed that the mean bias between the predicted and actual respiratory rate was 0.29 (standard deviation, 3.67). The percentage of cases where the predicted rate was within ± 10% and ± 20% of the actual rate was 42.4% and 66.7%, respectively. CONCLUSIONS We derived and validated a simple and easily applicable equation to predict the ventilator settings required to attain normocapnia during general anesthesia in children with moyamoya disease.
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Affiliation(s)
- Jumpei Kohara
- Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan
| | - Li Dong
- Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan.,Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Chikashi Takeda
- Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan.,Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Atsuko Shiraki
- Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan
| | - Hiroshi Fukagawa
- Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan
| | - Toshiyuki Mizota
- Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan
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Patino M, Chandrakantan A. Midgestational Fetal Procedures. CASE STUDIES IN PEDIATRIC ANESTHESIA 2019:197-201. [DOI: 10.1017/9781108668736.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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10
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Peters KS, Daniels AB. An 18-Month-Old With a White Optic Nerve Head Mass. JAMA Ophthalmol 2019; 137:1327-1328. [DOI: 10.1001/jamaophthalmol.2019.3798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Katherine S. Peters
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt University School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Anthony B. Daniels
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt University School of Medicine, Vanderbilt University, Nashville, Tennessee
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
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Georgalas I, Spyropoulos D, Paraskevopoulos T, Rotsos T. Morning Glory Disc Anomaly in a Child with Esotropia. J Pediatr 2018; 203:458-458.e1. [PMID: 30025671 DOI: 10.1016/j.jpeds.2018.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 06/01/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Ilias Georgalas
- First Ophthalmology Department National and Kapodistrian University of Athens Athens, Greece
| | - Dimitrios Spyropoulos
- First Ophthalmology Department National and Kapodistrian University of Athens Athens, Greece
| | | | - Tryfon Rotsos
- First Ophthalmology Department National and Kapodistrian University of Athens Athens, Greece
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The role of cerebral oximetry monitoring in off-pump coronary artery bypass surgery of Moyamoya disease. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:464-466. [PMID: 32082779 DOI: 10.5606/tgkdc.dergisi.2018.15271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 02/06/2018] [Indexed: 11/21/2022]
Abstract
Moyamoya disease is a chronic cerebrovascular disease characterized by the development of compensatory collateral vessels due to progressive narrowing or obstruction of the intracranial arteries. Neurological complications after coronary bypass in patients with Moyamoya disease may be prevented by recent technical developments, surgical modifications, and cerebral monitorization. The objective of perioperative anesthetic management is to provide balance between oxygen supply and consumption of the brain. In this case report, we aim to share our anesthetic experience in a patient with Moyamoya disease who underwent off-pump coronary artery bypass surgery and cerebral oximetry monitoring.
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Muraoka S, Araki Y, Kondo G, Kurimoto M, Shiba Y, Uda K, Ota S, Okamoto S, Wakabayashi T. Postoperative Cerebral Infarction Risk Factors and Postoperative Management of Pediatric Patients with Moyamoya Disease. World Neurosurg 2018; 113:e190-e199. [DOI: 10.1016/j.wneu.2018.01.212] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 11/28/2022]
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14
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Varadarajan JL. Anesthesia for Neurosurgical Procedures. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Vinícius Ribeiro E Silva M, Tavares Mendonça F, Garcia Dusi R. Anesthetic management in a child with moya-moya disease and sickle cell anemia: Case report. ACTA ACUST UNITED AC 2016; 63:604-607. [PMID: 27240737 DOI: 10.1016/j.redar.2016.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/30/2016] [Accepted: 04/06/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this case report is to describe the anesthetic management in a child with moya-moya disease and sickle cell anemia provided in a tertiary hospital. CASE A 6 year-old patient, diagnosed with moya-moya disease and sickle cell anemia, both conditions associated with a greater incidence of intracranial ischemic events, with a history of two strokes of the ischemic subtype, was submitted to general anesthesia for the execution of multiple cranial burr holes in order to produce the neovascularization in poorly perfused regions. There were no complications in the perioperative period and the child was discharged from the hospital on the second postoperative day. CONCLUSION Although scarcely described in the medical literature, the anesthetic management in a patient with moya-moya disease must ensure the maintenance of cerebral blood flow, normocapnia and the appropriate mean arterial pressure. In a patient with sickle cell disease, an adequate tissue perfusion, adequate oxygenation and hydration and strict pain control are to be primarily expected. The anesthesiologist is expected to know the physiopathology of both conditions to provide the best outcome for these patients.
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Affiliation(s)
- M Vinícius Ribeiro E Silva
- Teaching and Training Center of the Brazilian Society of Anesthesiology of the Hospital de Base do Distrito Federal, Brasilia, Brazil.
| | - F Tavares Mendonça
- Teaching and Training Center of the Brazilian Society of Anesthesiology of the Hospital de Base do Distrito Federal, Brasilia, Brazil
| | - R Garcia Dusi
- Teaching and Training Center of the Brazilian Society of Anesthesiology of the Hospital de Base do Distrito Federal, Brasilia, Brazil; Unit of Anesthesiology and Perioperative Medicine of the Hospital de Base do Distrito Federal, Brasilia, Brazil
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16
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Hong JC, Ramos E, Copeland CC, Ziv K. Transient Intraoperative Central Diabetes Insipidus in Moyamoya Patients Undergoing Revascularization Surgery: A Mere Coincidence? A & A CASE REPORTS 2016; 6:224-227. [PMID: 26795912 DOI: 10.1213/xaa.0000000000000287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We present 2 patients with Moyamoya disease undergoing revascularization surgery who developed transient intraoperative central diabetes insipidus with spontaneous resolution in the immediate postoperative period. We speculate that patients with Moyamoya disease may be predisposed to a transient acute-on-chronic insult to the arginine vasopressin-producing portion of their hypothalamus mediated by anesthetic agents. We describe our management, discuss pertinent literature, and offer possible mechanisms of this transient insult. We hope to improve patient safety by raising awareness of this potentially catastrophic complication.
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Affiliation(s)
- Joe C Hong
- From the *Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California; and †Medical Student, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California
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Chui J, Manninen P, Sacho RH, Venkatraghavan L. Anesthetic Management of Patients Undergoing Intracranial Bypass Procedures. Anesth Analg 2015; 120:193-203. [DOI: 10.1213/ane.0000000000000470] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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18
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Abstract
Recent advances in neurosurgery, neuromonitoring and neurointensive care have dramatically improved the outcome in patients affected by surgical lesions of central nervous system (CNS). Although most of these techniques were applied first in the adult population, paediatric patients present a set of inherent challenges because of their developing and maturing neurological and physiological status, apart from the CNS disease process. To provide optimal neuroanaesthesia care, the anaesthesiologist must have the knowledge of basic neurophysiology of developing brain and effects of various drugs on cerebral haemodynamics apart from the specialised training on paediatric neuroanaesthesia. This article highlights on the perioperative management of paediatric neurosurgical patients.
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Affiliation(s)
- Girija Prasad Rath
- Department of Neuroanaesthesiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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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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Abstract
The morning glory disc anomaly has distinctive clinical characteristics and is important to diagnose correctly so that associated central nervous system and vascular abnormalities are promptly identified and treated. This review covers the ophthalmic findings, clinical features, and histopathologic findings in patients with this rare developmental abnormality. The most common systemic associations are described and reviewed.
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Affiliation(s)
- Brian J Lee
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Ahn HJ, Kim JA, Lee JJ, Kim HS, Shin HJ, Chung IS, Kim JK, Gwak MS, Choi SJ. Effect of preoperative skull block on pediatric moyamoya disease. J Neurosurg Pediatr 2008; 2:37-41. [PMID: 18590393 DOI: 10.3171/ped/2008/2/7/037] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Stable hemodynamics, normocapnia, and adequate pain relief are considered important factors in the reduction of neurological complications in pediatric patients undergoing encephaloduroarteriomyosynangiosis (EDAMS) operations for the treatment of moyamoya disease. A preoperative skull block may reduce hemodynamic fluctuations and hypo- or hyperventilation due to emergence delirium or oversedation and provide adequate pain relief, thereby reducing postoperative morbidity. METHODS Pediatric patients (age 3-13 years) undergoing EDAMS surgery for moyamoya disease were randomly divided into a nerve block (NB) group (18 cases) or control group (21 cases). The treatment group patients received a preoperative NB (0.25% 5-8 ml bupivacaine mixed with 20-40 mg methylprednisolone) targeting the supraorbital, supratrochlear, auriculotemporal, and posterior auricular nerves. Patients in the control group did not receive NB. General anesthesia with sevoflurane was induced in both groups. RESULTS In the NB group, stable hemodynamic parameters were obtained with a lower sevoflurane concentration than in the control group. For delirious awakening, the odds ratio in the control group was 4.9 compared with the NB group. Pain and analgesic requirement were higher in the control patients than in the NB-treated patients during the postanesthesia care unit stay. However, the arterial CO(2) tension in the postanesthesia care unit did not differ between the 2 groups. The odds ratio in the control group for the rate of morbidity (cerebral infarction and reversible ischemic neurological deficits) during the first 24 hours following the operation was 3.2 compared with the NB group. CONCLUSIONS The use of skull block during EDAMS surgery provided easy hemodynamic control, calm awakening, and better pain relief and may be related to the reduced postoperative morbidity.
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Affiliation(s)
- Hyun Joo Ahn
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Kangnam-Gu, Seoul, Korea.
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