A review of the surgical and postoperative records of 127 revasculariz
ation procedures performed on 82 children with Moyamoya disease was do
ne to evaluate changes we made in anesthetic management in response to
perioperative complications. From 1982 to 1996, out of 82 children wh
o underwent revascularization surgery at our hospital, five developed
perioperative complications. One developed circulatory instability dur
ing surgery; the cause seemed to be a depth of anesthesia insufficient
for preventing surgical stress. To rectify this problem, an increased
dose of fentanyl was used to improve the maintenance of anesthesia. F
our patients developed cerebral infarction during the early postoperat
ive period due, in part, to inadequate management of postoperative pai
n. We began to administer supplemental doses of meperidine to patients
after they emerged From anesthesia to provide better control of posto
perative pain. Our review confirmed the effectiveness of these measure
s. The data suggest that during the perioperative management of childr
en with Moyamoya disease, close attention should be paid to balancing
the patients' anesthetic state against surgical stress and providing a
dequate postoperative analgesia. (C) 1997 Elsevier Science B.V.