Keyword
Moyamoya disease
Definition
Moyamoya is the Japanese term for “ puff of smoke”
Progressive stenosis of intracranial vessels로 인해 secondary development of an anastomotic capillary network가 발생,
그 결과 나타나는 작은 비정상 혈관들이 밀집해있는 angiographic finding을 표현한 명칭
Increased frequency - Intracranial aneurysms, symptoms of ischemia(ex.TIA, Cerebral infarcts) in children, hemorrhagic complication in adults
Treatment
Aimed at decreasing ischemic symptoms ; vasodilators and anticoagulants
Surgical treatment ; Extracranial-intracranial bypass or other indirect revascularization procedures
Management of anesthesia
Anticoagulant or antiplatelet drug therapy should be discontinued
Goal of induction and maintenance of anesthesia
(hypotension - risk of ischemia, hypertension - risk of hemorrhage)
(Avoid hypocapnia or phenylephrine; hypotension시 ephedrine 이나 dopamine 사용)
-> A-line monitoring (BP변화에 빠른 대처,가능하다면 induction 전 시행하여 stable induction sequence 진행)
IV Induction agent can be used safety, Sevoflurane induction 가능 (children)
Volatile anesthetic based technique - advantage of enhancing cerebral vasodilation
Excessive hyperventilation 금지! - cerebral vasoconstrictive effect
Hypovolemia, anemia 교정 필요
Postoperative complication - stroke, seizure, hemorrhage 로 인한 delayed awakening, new neurologic deficit 주의
**결국 Normotension, Normocapnia, Normovolemia를 잘 유지하면 됨!!
Reference
Stoelting’s Anesthesia and co-existing disease, sixth edition, Ch.10 Diseases affecting the brain, P.240-241