NM-266
A 16-year retrospective review of Moyamoya patient demographics and perioperative encounters at a tertiary pediatric hospital
Ma A, Vollmer E, Lang S, Simpao A
Children's Hospital of Philadelphia, Philadelphia, PA, United states
Introduction: Moyamoya disease is a chronic progressive cerebrovascular disorder that results in occlusion of intracranial arteries, especially the internal carotid artery. The name comes from the “puff of smoke†look on imaging caused by small anastomoses that the brain creates in order to compensate for reduced blood flow. The cause of Moyamoya is unknown, but an estimate of 10% of cases are familial, with a higher incidence in individuals of Japanese descent. Moyamoya patients are at an increased risk for stroke, and anesthetic management typically centers on maintaining normotensive blood pressure and cerebral perfusion. However, there remains a paucity of studies of Moyamoya perioperative data. In this study, we analyzed 16 years of perioperative data to investigate Moyamoya patient demographics, the procedures they undergo, and their overall exposure to anesthesia.
Methods: We analyzed the demographic and perioperative data extracted from our hospital’s anesthesia information management system and electronic health record system databases of Moyamoya patients from January 2001 to December 2016.
Results: Data on 92 Moyamoya patients were obtained. Gender was virtually identical with 47 patients being female and 45 being male. The patients included 3 of Asian decent (3.3%), 30 African Americans (32.6%), 41 Caucasian (44.6%), and 18 not reported (19.5%). At the first anesthesia exposure, the median age was 8.9 years old (interquartile range [IQR]: 3.8-14.0) and the median weight was 35.1 kg (IQR: 16.0, 52.2). The 92 patients accounted for 477 anesthetic exposures ranging from 1-37 exposures per patient. There were two ASA 1 patients (0.4%), 50 ASA 2 (10.5%), 389 ASA 3 (81.6%) and 35 ASA 4 (7.3%). There were 218 surgical cases, 172 magnetic resonance imaging (MRIs) studies, and 37 IR (interventional radiology) procedures. The most common surgical procedure was craniotomy for pial synangiosis (30 cases, 13.8%); the most common MRI was of the brain (139, 80.8%), and the most common IR procedure was cerebral angiogram (26, 70.3%). The median overall anesthesia time for Moyamoya patients was 142 minutes (IQR: 85-185). More specifically, the median anesthesia time in the operating room was 152 minutes (IQR: 74-213), in MRI was 121 minutes (IQR: 90-134), and in IR was 187 minutes (IQR: 158-208).
Discussion: This review granted insights into the Moyamoya patients undergoing anesthesia and surgery at our hospital. Anesthesia was given primarily for surgical procedures and radiological imaging. Surprisingly, the longest exposures to anesthesia occur in IR, not the operating room. Our review provides insights on the demographics and case lengths of Moyamoya patients at our institution and sets the foundation for future studies of this patient population. Such studies should take these factors into consideration when analyzing hemodynamic trends and perioperative outcomes.
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