[Moyamoya disease and sevoflurane anesthesia outside the surgery center: case report]

Moyamoya disease is a progressive cerebrovascular disorder implying anesthetic challenges due to patients poor brain perfusion, in addition to being a major cause for stroke in young people. This report aimed at describing a case of Moyamoyas disease in a patient submitted to general anesthesia with sevoflurane for a diagnostic procedure outside the surgery center.

Male child, 13 years old, physical status ASA IV, with Moyamoya disease and neurological sequelae after three previous strokes, chronic renal failure and systemic hypertension admitted for high digestive endoscopy. In the supine position and after monitoring, inhalational induction was attained through the tracheostomy canulla with sevoflurane (gradual inhaled concentration increase up to 6%) in a mixture of 50% oxygen/nitrous oxide. An intravenous catheter was inserted for 5% glucose solution infusion. Manual controlled ventilation was started and anesthesia was maintained with 4% sevoflurane in 50% oxygen/nitrous oxide. At the end of the procedure, all anesthetic agents were simultaneously withdrawn and 100% oxygen was administered. Anesthesia was satisfactory, with good hemodynamic stability, without complications and with early emergence.

Sevoflurane may open new perspectives for inhalational anesthesia in patients with neurological diseases to be submitted to outpatient procedures, since it provides hemodynamic stability and early emergence, while preserving brain physiology.