Comparison of hemodynamic stability in moyamoya syndrome patients under mask versus intravenous anesthetic induction
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Abstract
Background: Moyamoya syndrome is a chronic and progressive disorder, which affects the cerebral vasculature, especially at the Circle of Willis. Pathologically, the changes occur in the vessel and wall and lead to progressive narrowing and eventual occlusion of the internal carotid artery and possibly additional vessels. As the disorder progresses, decreased cerebral blood flow leads to dangerous ischemic events in pediatric patients, especially transient ischemic attacks and stroke. Surgery is necessary to reestablish proper blood flow however; prior to this a diagnostic cerebral angiogram is performed to visualize the blood vessels affected. During this procedure, intravenous (IV) anesthetic induction is typically used. However, IV access and insertion are likely to agitate children, leading to anxiety and crying. In moyamoya patients, crying and subsequent hyperventilation is a known trigger of ischemic events. Therefore, this study is investigating the safety of mask induction compared to IV for this procedure, which would help avoid episodes of crying.
Methods: Records from moyamoya patients admitted to Boston Children’s Hospital for a diagnostic cerebral angiogram during the period of 2007-2013 were analyzed retrospectively (n=98). The main focus was data analysis between patients who underwent IV versus mask induction to determine if there was equivalence of safety based on hemodynamic parameters. An unsafe blood pressure drop is clinically deemed as a 20% or greater drop from the patient’s baseline and this criteria was used when determining if a patient was a case (who experienced this unsafe event) or control. (who did not). Additionally, other intraoperative variables were analyzed for possible correlation with hemodynamic stability. Lastly, demographic patient information was gathered to gain an understanding of the population being analyzed. Statistical analysis was performed for all results when possible to determine significance. [TRUNCATED]
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Thesis (M.A.)--Boston University