Keck School of Medicine, University of Southern California, California, USA.
Curr Opin Anaesthesiol. 2024 Oct 1;37(5):439-445. doi: 10.1097/ACO.0000000000001411. Epub 2024 Jun 28.
The anesthetic management of patients with Moyamoya disease (MMD) is challenging and continues to evolve. The goal of this review is to provide updated recommendations on the anesthetic management of adult MMD patients based on the relevant existing literature.
Key findings include the importance of aggressive hydration preoperatively to sustain cerebral perfusion. Hypertension induced intraoperatively may prevent cerebral hypoperfusion. Vigilance against cerebral hyperperfusion after revascularization is necessary, with specific blood pressure targets recommended. Fluid management should aim for normovolemia to mild hypervolemia. Maintaining body temperature helps prevent cerebral vasospasm induced by hypothermia. Maintaining adequate oxygen supply during surgery is crucial. In cases of ischemic stroke, managing hematocrit and oxygen carrying capacity is essential to prevent further ischemia. Extubation decisions should consider baseline neurological function, while postoperative normocapnia helps prevent cerebral hyperperfusion and hypertension. In intensive care, cautious blood pressure management is crucial to prevent secondary complications.
Strategies in the preoperative, intraoperative, and postoperative anesthetic management of MMD patients should aim to maintain adequate cerebral perfusion to prevent cerebral ischemia.
烟雾病（MMD）患者的麻醉管理极具挑战性，且仍在不断发展。本综述的目的是根据相关现有文献，就成人 MMD 患者的麻醉管理提供最新建议。
主要发现包括术前积极水化以维持脑灌注的重要性。术中诱导的高血压可能防止脑灌注不足。在血管重建后需要警惕脑过度灌注，建议使用特定的血压目标。液体管理应旨在实现正常血容量至轻度高血容量。保持体温有助于预防低温引起的脑血管痉挛。手术期间维持充足的氧气供应至关重要。在缺血性卒中的情况下，控制血细胞比容和携氧能力对于防止进一步的缺血至关重要。拔管决策应考虑基线神经功能，而术后正常碳酸血症有助于预防脑过度灌注和高血压。在重症监护病房中，谨慎的血压管理对于预防继发性并发症至关重要。
MMD 患者麻醉管理的术前、术中和术后策略应旨在维持足够的脑灌注以预防脑缺血。
