Perioperative Management of Pediatric Patients with Moyamoya Arteriopathy.

Autor:	Gardner Yelton SE; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States., Williams MA; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States., Young M; Child Life Department, Johns Hopkins Hospital, Baltimore, Maryland, United States., Fields J; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States., Pearl MS; Department of Radiology, Children's National Hospital, Washington, District of Columbia, United States.; Departments of Radiology and Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, United States., Casella JF; Department of Pediatrics, Division of Hematology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States., Lawrence CE; Department of Pediatrics, Division of Hematology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States., Felling RJ; Department of Neurology, Division of Pediatric Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States., Jackson EM; Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, United States., Robertson C; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States., Scafidi S; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States., Lee JK; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States., Cohen AR; Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, United States., Sun LR; Department of Neurology, Division of Pediatric Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States.
Jazyk:	angličtina
Zdroj:	Journal of pediatric intensive care [J Pediatr Intensive Care] 2021 Jul 01; Vol. 12 (3), pp. 159-166. Date of Electronic Publication: 2021 Jul 01 (Print Publication: 2023).
DOI:	10.1055/s-0041-1731667
Abstrakt:	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. Competing Interests: Conflict of Interest None declared. (Thieme. All rights reserved.)
Databáze:	MEDLINE
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