Namigar TURGUT, HATİCE AYSEL ALTAN, Aygen TÜRKMEN, Çağlayan KÖKSAL, Ali KARAHAN, Cem GÖKDUMAN

Moyamoya hastalığı ve anestezi (olgu sunumu)

Moyamoya hastalığı, spesifik, kronik, serebrovasküler oklüziv bir hastalıktır. Bilateral internal karotid arterin terminal parçasında stenoz veya oklüzyon ile karekterizedir. Arteryel oklüzyonun komşuluğunda anormal vasküler ağ örgüsü mevcuttur. Biz Moyamoya hastalığı tanısı nedeniyle operasyona alınan 7 ve 13 yaşında 2 olguyu sunarak, bu hastalıktaki iki farklı anestezik yaklaşımı irdeledik. Birinci olgumuz olan yedi yaşındaki kız çocuğu premedikasyon yapılmadan ameliyat masasına alındı ve EKG, kan basıncı ve pulsoksimetre monitörizasyonu uygulandı. %100 $0_2$ ile 2 dakika preoksijenasyonun ardından propofol 2 mg $kg^{-1}$, sisatrakuryum 0.1 mg $kg^{-1}$, metilprednizolon 60 mg ve fentanil l $mu$g $kg^{-1}$ ile indüksiyonu sağlanan hastanın idamesinde 9 mg $kg^{-1}$ $sa^{-1}$ propofol infüzyonu, % 50 N20 + % 50 O2 ve 0.1 mg $kg^{-1}$ $sa^{-1}$ sisatrakuryum kullanıldı. ikinci olgumuz ise on üç yaşındaki kız çocuğu premedikasyon yapılmadan ameliyat masasına alındı. % 100 O2 ile 2 dakika preoksijenasyonun ardından propofol 2 mg $kg^-1$, sisatrakuryum 0.1 mg $kg^-1$, fentanil l $mu$g $kg^{-1}$ ile indüksiyonu sağlanan hastanın idamesinde %2 sevofluran, % 50 hava, % 50 O2 ve 0.1 mg $kg^{-1}$ $sa^{-1}$ sisatrakuryum kullanıldı. Her iki olgumuzda da peroperatif komplikasyon gözlenmedi. Ekstübasyon ameliyathanede yapıldı. Postoperatif dönemde sorunu olmayan hastalar 7. günde taburcu edildiler. Sonuç olarak, Moyamoya hastalığında intraoperatif ve postoperatif hemodinamik değişikliklerden ve hiperventilasyondan sakınılmak, serebral perfüzyon basıncı normal sınırlarda tutulması gerektiği akılda bulundurulmalıdır.

Anahtar Kelimeler:

Moyamoya hastalığı, Anestezi

Moyamoya disease and anesthesia (case report)

Moyamoya disease is a spesific chronic cerebrovascular occlusive disorder characterized by stenosis or occlusion of the terminal portions of the bilateral internal carotid arteries and abnormal vascular network in the vicinity of the arterial occlusion. This is the report of the anesthetic management of two cases who are operated because of Moyamoya disease. In both cases, induction of anesthesia was carried out with propofol and maintenance with TIVA or sevoflurane. The first case, seven years old patient was taken to the operating room without premedication. After giving %100 oxygen for two minutes, induction of anesthesia was provided with propofol 2 mg $kg^{-1}$, cisatracrium 0.1 mg $kg^{-1}$, methylprednisolone 60 mg andfentanyl l $mu$g $kg^{-1}$. Anesthesia was maintained with propofol infusion, % 50 N2O + % 50 O2 and cisatracrium. There was not any intraoperative complication and the patient was extubated in the operating room. The second case, thirteen years old patient was taken to the operating room without premedication. Induction of anesthesia was provided with propofol 2 mg $kg^{-1}$, cisatracrium 0.1 mg $kg^{-1}$ andfentanyl 1 $mu$g $kg^{-}1$. Anesthesia was maintained with %2 sevoflurane, % 50 O2 + % 50 air and cisatracrium. There were no intraoperative complications and the patient was extubated in the operating room. As a conclusion, it is important to avoid intraoperative and postoperative hemodynamic changes and hyperventilation in Moyamoya disease. Cerebral perfusion must be kept within normal limits.

Keywords:

Moyamoya Disease, Anesthesia,

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1. Sakurai K, Horiuchi Y, Ikeda H, Ikezaki K, Yoshimoto T, Fukui M, Arinami T. A novel susceptibility locus for moyamoya disease on chromosome 8q23. J Hum Genet. 2004; 22: 305-8.
2. Suzuki J, Kodoma N. Moyamoya disease-a review. Stroke 1983; 14: 104-9.
3. Sydney JP. Risk factors of moyamoya disease in Canada and USA. Clinical Neurology and Neurosurgery Supply 1997; 2: 45-8.
4. Tetsura K, Shigekiyo F, Kohkichi H. Usefulness of multiple burr hole operation for child moyamova disease. No Shinkei Geka 1998;26:217-24.
5. Takao E, Kiyoyuki Y. Moyamoya disease associated with persistent primitive hypoglossal artery. Pediatr Neurosurg 2001; 35: 262-5.
6. Petty LA. Anesthetic management of a patient with moyamoya disease; a case report. AANA"j. 1993; 61 (3): 277-81.
7. Sato K, Shirane R, Kato M, et al. Effect of inhalational anesthesia on cerebral circulation in Moyamoya disease. J Neurosurg Anesthesiol 1999: Jan 1(1): 25-30.
8. Furuya A, Matsukova T, Ozaki M. et al. Propofol anaesthesia for cesarean section successfully managed in a patient with moyamoya disease. J Clin Anesth 1998; May 10 (3): 242-5.
9. Abouleish E, Wiggins M, Ali V. Combined spinal and epidural anesthesia for cesarean section in a parturient with moyamoya disease. Acta Anaesthesiol Scand. 1998; Oct 42 (9): 1120-3.
10. Oshima H, Katayama Y, Hirayama T, et al. Intracerebral steal phenomenon associated with global hyperemia in moyamoya disease during revascularization surgery. J Neurosurg. 2000: Jun 92 (6): 949-54.
11. Kurehara K, Ohnishi H, Touho H, et al. Cortical blood flow response to hypercapnia during anaesthesia in Moyamoya disease. Can J Anaesth. 1993: Aug 40 (8): 709-13.
12. Yasukawa K, Okudera H, Hongo K. Adult moyamoya disease with transcranial carotid-external carotid anastomosis through burr hole. No Shinkei Geka 1990; 18: 373-80.
13. Matsushioma Y. Moyamoya disesase. Principlles and practice of pediatric nerosurgery 1st. Ed, New York Thieme, 1999; 1053-70.