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Intraoperative Anesthesiology Management and Patient Outcomes for Surgical Revascularization for Moyamoya Disease: A
George W Williams1, William S Jones2, Rabail Chaudhry3
1Department of Anesthesiology, University of Texas John P. and Katherine G. McGovern Medical School, Houston, Texas, United States.
Background:
Moyamoya disease (MMD) is a rare cerebrovascular condition, often presenting as a headache or stroke in adults. Anesthetic management of this illness may challenge providers because it can affect the long-term neurologic outcome and hospital length of stay (LOS) in patients with MMD.
Materials And Methods:
A literature search was conducted to assess etiology and epidemiology, as well as existing reports of intraoperative management of MMD. Due to sparse findings, the search was expanded to include studies of the use of intraoperative anesthetic agents during other neurosurgical procedures. We also retrospectively reviewed all MMD cases from January 1, 2009, to December 31, 2015, at Memorial Hermann Hospital-Texas Medical Center, where intraoperative management involved craniotomy and surgical revascularization. Data were collected primarily on the use of several anesthetic agents. The LOS and any adverse events were also recorded for each case. The data were divided into two equivalent case cohorts: (1) January 1, 2009, to February 18, 2013, and (2) February 19, 2013, to December 31, 2015.
Results:
Remifentanil use notably increased between the first and second time periods while fentanyl use decreased. Desflurane usage also demonstrated an observed increase when our two cohorts were compared. Additionally, there was a decrease in the mean LOS between the first and second periods of 3.9 and 3.3 days, respectively.
Conclusion:
Increasing use of remifentanil in MMD cases could be attributed to its ability to provide more stable hemodynamics during induction, maintenance, and emergence of anesthesia when compared with fentanyl. Lower systolic pressures, diastolic pressures, and heart rates were reported in patients receiving remifentanil over fentanyl.
Insights
Anesthetic management for Moyamoya disease (MMD) using remifentanil showed improved hemodynamic stability and reduced hospital length of stay (LOS) compared to fentanyl. This shift in anesthetic agents may enhance patient outcomes in MMD surgical revascularization.
Area of Science:
- Anesthesiology
- Neurosurgery
- Cerebrovascular Medicine
Background:
- Moyamoya disease (MMD) is a rare cerebrovascular condition impacting adults, often presenting with headaches or stroke.
- Anesthetic management for MMD poses challenges, potentially influencing neurologic outcomes and hospital length of stay (LOS).
Purpose of the Study:
- To assess anesthetic agent usage in Moyamoya disease (MMD) patients undergoing surgical revascularization.
- To evaluate the impact of anesthetic choices on hemodynamic stability and hospital LOS in MMD patients.
Main Methods:
- Literature search for MMD etiology, epidemiology, and intraoperative anesthetic management.
- Retrospective review of MMD cases (2009-2015) involving craniotomy and surgical revascularization.
- Comparison of anesthetic agents, LOS, and adverse events between two case cohorts.
Main Results:
- Increased use of remifentanil and desflurane, with decreased fentanyl use, observed between the two study periods.
- A reduction in mean hospital LOS from 3.9 to 3.3 days was noted between the cohorts.
- Remifentanil use correlated with more stable hemodynamics compared to fentanyl.
Conclusions:
- The increased adoption of remifentanil in MMD anesthesia is likely due to its superior hemodynamic stability during anesthetic procedures.
- Remifentanil administration was associated with lower systolic and diastolic pressures and heart rates than fentanyl.
- Anesthetic management strategies may play a crucial role in optimizing outcomes for MMD patients.
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