[Anesthesiologic implications of moyamoya disease]

A 34-year-old woman 22 weeks pregnant suffered cerebral hemorrhage, requiring admission to the intensive care unit and mechanical ventilation. She recovered without sequelae. The diagnosis was moyamoya disease and she was scheduled for elective cesarean delivery at 38 weeks of gestation. After appropriate preoperative study and complementary testing (echocardiogram, computerized axial tomography of the brain and determination of anti-cardiolipin and other antibodies, which were normal) the patient was given intradural anesthesia with 15 mg of 0.5% bupivacaine and 24 micrograms of fentanyl, with continuous monitoring of blood pressure, tympanic temperature and neurological variables. Warm intravenous fluids and ephedrine (100 to 250 micrograms/min) were perfused. No noteworthy neurological events or hemodynamic changes occurred during or after surgery. Postoperative analgesia was provided with 2 mg/12 h of morphine through an epidural catheter.