Propofol anesthesia for cesarean section successfully managed in a patient with moyamoya disease

We report a case of general anesthesia in a 25 year-old female patient with moyamoya disease who presented for cesarean section. General anesthesia was induced with propofol 100 mg, succinylcholine 50 mg, and nicardipine 1 mg intravenously (i.v.), and maintained with 60% nitrous oxide in oxygen. Just after the clamp of the umbilical cord, propofol 10 mg/kg/hr following propofol 50 mg pentazocine 15 mg vecuronium 8 mg, and methylergometrine maleate 0.2 mg were given i.v. The rate of infusion of propofol was reduced to 8 mg/kg/hr 10 minutes after the clamp and reduced to 6 mg/kg/hr 20 minutes after the clamp. Additional pentazocine 15 mg was given i.v. Blood pressure was maintained between 110 and 145 systolic, and 50 and 85 diastolic mmHg, and end-tidal carbon dioxide was between 34 and 36 mmHg. No postoperative deterioration of the patient's neurologic findings occurred. For the anesthetic management of moyamoya disease patients, especially in delivery, it is important to avoid hemodynamic changes and to maintain cerebral blood flow (CBF). We used propofol for hemodynamic stability and avoided hyperventilation so as to maintain CBF. We successfully managed the patient perioperatively.