Propofol Increased Cerebral Perfusion as Compared With Isoflurane During a Cerebral Angiography in a Child With Moyamoya Disease

Culebras, Xavier; Martin, Jean-Baptiste; Treggiari-Venzi, Miriam M.; Ruefenacht, Daniel; Habre, Walid

doi:10.1097/00008506-200301000-00009

Cited by 8 publications

(4 citation statements)

References 9 publications

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“…Previous reports on the influence of different anesthetic methods on the occurrence of TNEs have suggested that the preoperative severity of illness and the surgical technique may be related to postoperative neurological symptoms, with no differences because of inhalation and intravenous anesthesia. [9][10][11][12] However, these findings remain a subject of debate. Some have suggested that TIVA using propofol, which lacks cerebral vasodilatory properties, may be better suited for maintaining CBF.…”

Section: Discussionmentioning

confidence: 99%

“…Previous findings have reported no significant differences between inhalational and intravenous anesthesia methods. [9][10][11][12] Conversely, it has been demonstrated that intravenous anesthesia is better suited for maintaining regional CBF because inhalation anesthesia (IA) tends to dilate cerebral blood vessels and increase intracranial pressure, potentially leading to cerebral steal phenomena intraoperatively. 13 In light of recent advancements in anesthesia methods, this study aimed to examine whether contemporary anesthesia methods influence the occurrence of postoperative neurological symptoms, with a specific focus on transient neurological events (TNEs).…”

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confidence: 99%

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Inhalational Anesthesia Reduced Transient Neurological Events After Revascularization Surgery for Moyamoya Disease

Kaku,

Ohmori,

Kameno

et al. 2023

Neurosurgery

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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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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Inhalational Anesthesia Reduced Transient Neurological Events After Revascularization Surgery for Moyamoya Disease

Kaku,

Ohmori,

Kameno

et al. 2023

Neurosurgery

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“…The effects of inhalational anesthesia on the cerebral circulation in patients who are undergoing revascularization procedures for moyamoya disease were reported to be decreased regional cortical blood flow, increased jugular bulb oxygen saturation and decreased frontal regional oxygen saturation, whereas these effects did not occur with total intravenous anesthesia [10]. Propofol was associated with better preservation of the cerebral circulation as compared to that of isoflurane in the case of a child with moyamoya disease during a cerebral angiography procedure [11]. The optimal range of CO 2 for isoflurane is more restricted than that for propofol and presumably because isoflurane induces hyperemia by itself and this hyperemia decreases the cerebral blood flow [7].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative acute brain swelling when performing indirect anastomosis in a patient with moyamoya disease -A case report-

Nho

Choi

et al. 2010

Korean J Anesthesiol

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A 6-year-old male patient who was suffering from a cold and a transient ischemic attack was scheduled to undergo encephalo-duro-arterio-synangiosis for treating his moyamoya disease. Acute brain edema occurred just after opening the dura mater. Head elevation, reduction of the head rotation and hyperventilation were done. The inhalational agents were discontinued and total intravenous anesthesia was started. The swelling was reduced after intravenously infusing mannitol. An abrupt return from hypocapnia to normocapnea during the induction of general anesthesia was thought to be the cause of the acute brain swelling. In conclusion, correction of hypocapnea needs to be performed gradually during the induction of anesthesia and when performing an operation for treating a patient with moyamoya disease.

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“…Although several published case reports and retrospective studies have compared the effects of total IV anesthesia and inhaled anesthesia on neurologic outcomes of pediatric patients with moyamoya, no particular anesthetic has been shown to reduce the risk of neurologic complications. 17,[31][32][33][34][35] To our knowledge, various volatile gas anesthetics have not been compared in pediatric patients with moyamoya in a randomized study. Therefore, we are unable to make recommendations on specific anesthetic regimens but rather outline our general intraoperative approach.…”

Section: Intraoperativementioning

confidence: 99%

Perioperative Management of Pediatric Patients with Moyamoya Arteriopathy

Yelton

Williams

Young

et al. 2021

J Pediatr Intensive Care

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Pediatric patients with moyamoya arteriopathy are at high risk for developing new onset transient or permanent neurologic deficits secondary to cerebral hypoperfusion, particularly in the perioperative period. It is therefore essential to carefully manage these patients in a multidisciplinary, coordinated effort to reduce the risk of new permanent neurologic deficits. However, little has been published on perioperative management of pediatric patients with moyamoya, particularly in the early postoperative period during intensive care unit admission. Our pediatric neurocritical care team sought to create a multidisciplinary periprocedural evidence- and consensus-based care pathway for high-risk pediatric patients with moyamoya arteriopathy undergoing anesthesia for any reason to decrease the incidence of periprocedural stroke or transient ischemic attack (TIA). We reviewed the literature to identify risk factors associated with perioperative stroke or TIA among patients with moyamoya and to gather data supporting specific perioperative management strategies. A multidisciplinary team from pediatric anesthesia, neurocritical care, nursing, child life, neurosurgery, interventional neuroradiology, neurology, and hematology created a care pathway for children with moyamoya undergoing anesthesia, classifying them as either high or standard risk, and applying an individualized perioperative management plan to high-risk patients. The incidence of neurologic sequelae before and after pathway implementation will be compared in future studies.

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Propofol Increased Cerebral Perfusion as Compared With Isoflurane During a Cerebral Angiography in a Child With Moyamoya Disease

Cited by 8 publications

References 9 publications

Inhalational Anesthesia Reduced Transient Neurological Events After Revascularization Surgery for Moyamoya Disease

Inhalational Anesthesia Reduced Transient Neurological Events After Revascularization Surgery for Moyamoya Disease

Intraoperative acute brain swelling when performing indirect anastomosis in a patient with moyamoya disease -A case report-

Perioperative Management of Pediatric Patients with Moyamoya Arteriopathy

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