Perioperative Management of Pediatric Patients with Moyamoya Arteriopathy

Sarah E. Gardner Yelton, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States.
Monica A. Williams, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States.
Mollie Young, Child Life Department, Johns Hopkins Hospital, Baltimore, Maryland, United States.
Jennifer Fields, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States.
Monica S. Pearl, Department of Radiology, Children's National Hospital, Washington, District of Columbia, United States.
James F. Casella, Department of Pediatrics, Division of Hematology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States.
Courtney E. Lawrence, Department of Pediatrics, Division of Hematology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States.
Ryan J. Felling, Department of Neurology, Division of Pediatric Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States.
Eric M. Jackson, Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, United States.
Courtney Robertson, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States.
Susanna Scafidi, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States.
Jennifer K. Lee, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States.
Alan R. Cohen, Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, United States.
Lisa R. Sun, Department of Neurology, Division of Pediatric Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States.

Document Type

Journal Article

Publication Date

9-1-2023

Journal

Journal of pediatric intensive care

Volume

12

Issue

3

DOI

10.1055/s-0041-1731667

Keywords

moyamoya; pediatrics; perioperative; stroke

Abstract

Pediatric patients with moyamoya arteriopathy are at high risk for developing new onset transient or permanent neurologic deficits secondary to cerebral hypoperfusion, particularly in the perioperative period. It is therefore essential to carefully manage these patients in a multidisciplinary, coordinated effort to reduce the risk of new permanent neurologic deficits. However, little has been published on perioperative management of pediatric patients with moyamoya, particularly in the early postoperative period during intensive care unit admission. Our pediatric neurocritical care team sought to create a multidisciplinary periprocedural evidence- and consensus-based care pathway for high-risk pediatric patients with moyamoya arteriopathy undergoing anesthesia for any reason to decrease the incidence of periprocedural stroke or transient ischemic attack (TIA). We reviewed the literature to identify risk factors associated with perioperative stroke or TIA among patients with moyamoya and to gather data supporting specific perioperative management strategies. A multidisciplinary team from pediatric anesthesia, neurocritical care, nursing, child life, neurosurgery, interventional neuroradiology, neurology, and hematology created a care pathway for children with moyamoya undergoing anesthesia, classifying them as either high or standard risk, and applying an individualized perioperative management plan to high-risk patients. The incidence of neurologic sequelae before and after pathway implementation will be compared in future studies.

Department

Radiology

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