Anesthetic Management of Patients Undergoing Intracranial Bypass Procedures

Chui, Jason; Manninen, Pirjo; Sacho, Raphael; Venkatraghavan, Lashmi

doi:10.1213/ane.0000000000000470

Cited by 21 publications

(20 citation statements)

References 69 publications

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“…The general recommendation is to maintain “normotension” or to keep the blood pressure within 10–20 % of the preoperative established baseline blood pressure for all patients. (Chui et al 2015 )…”

Section: Discussion and Evaluationmentioning

confidence: 99%

Superficial temporal artery-to-middle cerebral artery bypass surgery for middle cerebral artery stenosis in a patient with cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy

et al. 2015

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Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy is a rare hereditary small vessel disease. Ischemic events are the main clinical manifestation of this condition. Here, we present a case in which superficial temporal artery-to-middle cerebral artery anastomosis was performed in a patient with cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy who developed cerebral infarctions caused by severe middle cerebral artery stenosis. Cerebral blood flow and cerebrovascular reactivity were effectively improved using double anastomoses. To our knowledge, surgical revascularization for patients with this condition has not yet been described in the literature. Superficial temporal artery-to-middle cerebral artery anastomosis is effective for patients with cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy who show marked regional cerebral hypoperfusion.

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Section: Discussion and Evaluationmentioning

confidence: 99%

Superficial temporal artery-to-middle cerebral artery bypass surgery for middle cerebral artery stenosis in a patient with cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy

et al. 2015

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“…For optimal perfusion across stenotic vessels and collaterals, blood pressure was maintained to patient-specific needs (baseline asymptomatic or 20% over the preoperative blood pressure baseline). 33 34 This was supplemented by ensuring normovolaemia to a slightly hypervolaemic fluid state, early during the operation. To avoid cerebral vasoconstriction, intraoperative ventilation was targeted to normocapnia, while avoiding hyperventilation.…”

Section: Discussionmentioning

confidence: 99%

“…To avoid cerebral vasoconstriction, intraoperative ventilation was targeted to normocapnia, while avoiding hyperventilation. 29 34 To reduce the stroke risk associated with embolic events in ICAS, perioperative, full aspirin doses were maintained. 29 34 …”

Section: Discussionmentioning

confidence: 99%

Rigorous anaesthesia management protocol for patients with intracranial arterial stenosis: a prospective controlled-cohort study

et al. 2016

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ObjectivesReducing variability is integral in quality management. As part of the ongoing Encephaloduroarteriosynangiosis Revascularisation for Symptomatic Intracranial Arterial Stenosis (ERSIAS) trial, we developed a strict anaesthesia protocol to minimise fluctuations in patient parameters affecting cerebral perfusion. We hypothesise that this protocol reduces the intraoperative variability of targeted monitored parameters compared to standard management.DesignProspective cohort study of patients undergoing encephaloduroarteriosynangiosis surgery versus standard neurovascular interventions. Patients with ERSIAS had strict perioperative management that included normocapnia and intentional hypertension. Control patients received regular anaesthetic standard of care. Minute-by-minute intraoperative vitals were electronically collected. Heterogeneity of variance tests were used to compare variance across groups. Mixed-model regression analysis was performed to establish the effects of treatment group on the monitored parameters.SettingTertiary care centre.Participants24 participants: 12 cases (53.8 years±16.7 years; 10 females) and 12 controls (51.3 years±15.2 years; 10 females). Adults aged 30–80 years, with transient ischaemic attack or non-disabling stroke (modified Rankin Scale <3) attributed to 70–99% intracranial stenosis of the carotid or middle cerebral artery, were considered for enrolment. Controls were matched according to age, gender and history of neurovascular intervention.Main outcome measuresVariability of heart rate, mean arterial blood pressure (MAP), systolic blood pressure and end tidal CO2 (ETCO2) throughout surgical duration.ResultsThere were significant reductions in the intraoperative MAP SD (4.26 vs 10.23 mm Hg; p=0.007) and ETCO2 SD (0.94 vs 1.26 mm Hg; p=0.05) between the ERSIAS and control groups. Median MAP and ETCO2 in the ERSIAS group were higher (98 mm Hg, IQR 23 vs 75 mm Hg, IQR 15; p<0.001, and 38 mm Hg, IQR 4 vs 32 mm Hg, IQR 3; p<0.001, respectively).ConclusionsThe ERSIAS anaesthesia protocol successfully reduced intraoperative fluctuations of MAP and ETCO2. The protocol also achieved normocarbia and the intended hypertension.Trial registration numberNCT01819597; Pre-results.

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“…No specific anesthetic agent used for maintenance has been found to change neurological outcomes after pediatric moyamoya surgeries. 30,35 There is some evidence that intravenous anesthetic using propofol decreases ICP by decreasing cerebral blood volume and that decreased ICP may improve cerebral perfusion, although this has not been shown to affect outcomes. 25,31,36 More important than the maintenance anesthetic used is maintaining cerebral perfusion pressure through adequate blood pressure, discussed below.…”

Section: Ane S the Ti C Manag Ement Of Moyamoya D Is E A S E Surg Ementioning

confidence: 99%

Moyamoya disease in children and its anesthetic implications: A review

Giustini

Stone

Ramamoorthy

2020

Pediatric Anesthesia

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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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Anesthetic Management of Patients Undergoing Intracranial Bypass Procedures

Cited by 21 publications

References 69 publications

Superficial temporal artery-to-middle cerebral artery bypass surgery for middle cerebral artery stenosis in a patient with cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy

Superficial temporal artery-to-middle cerebral artery bypass surgery for middle cerebral artery stenosis in a patient with cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy

Rigorous anaesthesia management protocol for patients with intracranial arterial stenosis: a prospective controlled-cohort study

Moyamoya disease in children and its anesthetic implications: A review

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