Perioperative management protocols for children with moyamoya disease

Protocols for prevention of cerebral ischemic attacks caused by hyperventil ation resulting from crying, as observed in perioperative pediatric moyamoy a patients, were evaluated. The first protocol involved the use of sedation when staff were setting up the intravenous lines, performing neuroimaging studies, and controlling postoperative pain. The second involved the use of wound-handling techniques designed to ease postoperative wound care; these included steristrip closure, use of paraffin gauze and not using adhesive tapes. We compared 14 and 11 surgical cases handled before and after the pr otocols were introduced, respectively. The number of patients with perioper ative cerebral infarction decreased from 2 to 0. Appropriate sedation reduc ed the incidence of transient ischemic attacks from 28.6% to 3.7%. The aver age postoperative hospital stay was similarly reduced, from 21.3 days to 16 .1 days, as a consequence of the reduced incidence of complications. It is concluded that the perioperative risks can be minimized when invasive proce dures are managed according to our protocols.