ANESTHETIC MANAGEMENT OF CHILDREN WITH MOYAMOYA-DISEASE

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.