Anesthesia Depresses Cerebrovascular Reactivity to Acetazolamide in Pediatric Moyamoya Vasculopathy

Area of Science:

• Neurology
• Radiology
• Pediatrics

Background:

• Cerebrovascular reactivity (CVR) measurements are critical for managing moyamoya vasculopathy (MMV).
• Anesthesia is often used in pediatric MMV patients to mitigate motion during CVR assessment.
• The impact of anesthesia on CVR in pediatric MMV remains unclear.

Purpose of the Study:

• To investigate the effect of anesthesia on CVR in pediatric moyamoya vasculopathy patients.
• To compare CVR measurements between awake and anesthetized pediatric MMV patients using specific MRI techniques.

Main Methods:

• Compared CVR using multidelay-ASL and BOLD MRI with acetazolamide challenge in awake and anesthetized pediatric MMV patients.
• Focused analysis on the unaffected cerebellum to minimize disease heterogeneity influence.
• Included ten awake and nine anesthetized patients in the study.

Main Results:

• Anesthetized patients showed significantly lower post-acetazolamide cerebral blood flow (CBF) and ASL-CVR.
• BOLD-CVR increase, maximum slope, and time to maximum BOLD-increase were all significantly reduced in the anesthesia group.
• These findings indicate a distinct difference in CVR response between awake and anesthetized MMV patients.

Conclusions:

• Anesthesia significantly alters cerebrovascular reactivity measurements in pediatric moyamoya vasculopathy patients.
• The study hypothesizes that these findings may extend to other conditions and CVR assessment methods under anesthesia.
• Caution is advised when interpreting CVR status in MMV patients assessed under anesthesia due to altered responses.