Article

Moyamoya disease and anesthesia

Pediatric Anesthesia (Impact Factor: 2.44). 11/2005; 15(12):1111 - 1115. DOI: 10.1111/j.1460-9592.2005.01576.x
Source: PubMed

ABSTRACT Moyamoya disease is a condition that results from bilateral stenosis or obstruction of the intracranial arteries at the base of the brain. Patients exhibit ischemic symptoms, and vascular reconstruction is the therapy of choice. Surgical treatment for Moyamoya disease is often complicated by cerebral ischemia, so the goal in perioperative management is to maintain the balance between oxygen supply and demand in the brain. This report presents three cases of Moyamoya disease in patients under 3 years of age, and discusses anesthesia management issues for pediatric patients with this condition.

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    ABSTRACT: Cortical blood flow (CoBF) was measured continuously by the laser-Doppler method to evaluate the effect of hypercapnia on cortical blood flow during ten surgical procedures in ten young patients (mean ± SD 9.3 ± 6.4 yr) with Moyamoya disease. The CoBF was 42.8 ± 13.4 (ml·100 g−1. min−1) during normocapnia (PaCO2 = 39.0 ± 2.4 mmHg), and 38.7 ± 14.4 during hypercapnia (PaCO2 = 47.1 ± 2.5 mmHg). There was a decrease in CoBF with hypercapnia (P < 0.05) so that the normal CoBF response to hypercapnia was impaired during surgery in the patients with Moyamoya disease. He concluded that patients with Moyamoya disease have a precarious cerebral circulation and hypercapnia may be detrimental to the cortical circulation. This suggests that normocapnia is preferable to hypercapnia in patients with Moyamoya disease during anaesthesia. Pendant dix interventions chirurgicales pratiquées chez dix jeunes patients (âge moyen 9,3 ± 6,4 ans) souffrant de la maladie de Moyamoya, le débit sanguin cortical (DSCo) est mesuré continuellement par la méthode Laser-Doppler dans le but d’évaluer les effets de l’hypercapnie sur le débit sanguin cortical. Le DSCo (ml·100 g−1· min−1) est de 42,8 ± 13,4 pendant la normocapnie (PaCO2 = 39,0 ± 2,4 mmHg) et de 38,7 ± 14,4 pendant l’hypercapnie (PaCO2 = 47,1 ± 2,5 mmHg). La baisse du débit pendant hypercapnie est significative (P < 0,05). Ce qui démontre que la réponse du débit sanguin cérébral est perturbée pendant la chirurgie de la maladie de Moyamoya. On conclut que cette maladie a une influence néfaste sur la circulation cérébrale pendant l’hypercapnie. Ceci suggère que dans la maladie de Moyamoya, la normocapnie est préférable à l’hypercapnie.
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