接受全身麻醉进行非血管重建手术的小儿 Moyamoya 患者神经系统不良事件发生率低。

IF 3.2 3区医学 Q2 CLINICAL NEUROLOGY

Pediatric neurology Pub Date : 2024-09-13 DOI:10.1016/j.pediatrneurol.2024.09.008

Shiri Zarour MD , Nitzan Zohar MD , Jonathan Roth MD , Shelly I. Shiran MD , Tali Jonas Kimchi MD , Udi Sadeh-Gonik MD , Margaret Ekstein MD , Moran Hausman-Kedem MD

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引用次数: 0

摘要

背景：全身麻醉对 MMA 患者有很大风险，但在非血管重建手术中的风险仍不清楚。有关非血管重建手术中全身麻醉风险的数据很少。因此，我们旨在评估因非血管重建手术而接受全身麻醉的 MMA 儿科患者中神经系统不良事件（NAEs）的发生率：我们在一家三级儿科转诊中心开展了一项回顾性队列研究，研究对象为2014年1月至2023年7月期间接受非血管重建手术全身麻醉的18岁以下MMA患者。麻醉后NAE是指术后30天内出现短暂性脑缺血发作、癫痫发作、精神状态改变、严重头痛或动脉缺血性卒中（AIS）的证据：在 38 名患者（中位年龄[四分位间差]：8.3 [5.0, 12.7]岁；57%为女性）的 149 例手术中，124 例（83.2%）为影像学检查和血管造影，25 例（16.8%）为外科手术。大多数（111 例，74.5%）手术前都按照本机构的方案进行了术前高水化治疗。一名放射后MMA、泛垂体功能亢进和糖尿病未得到控制的患者在接受脑室腹腔分流改造手术后发生急性AIS，尽管在术前进行了高补液治疗，但仍发生了麻醉后NAE，发生率为0.67%（149例中有1例）。在全身麻醉下进行造影检查后，没有发生非器官功能障碍：结论：我们的研究结果表明，对患有 MMA 的儿童患者进行全身麻醉以进行非血管重建手术是安全的。由于神经放射学随访对 MMA 患儿非常重要，因此这些信息对于安抚患者及其家属的情绪非常有价值。

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Low Incidence of Neurological Adverse Events Among Pediatric Patients With Moyamoya Undergoing General Anesthesia for NonRevascularization Procedures

Background

General anesthesia poses a significant risk for patients with MMA, yet its risk in the setting of nonrevascularization procedures remains unclear. Data regarding the risk of general anesthesia for nonrevascularization procedures are scarce. We therefore aimed to assess the incidence of neurological adverse events (NAEs) among pediatric patients with MMA undergoing general anesthesia for nonrevascularization procedures.

Methods

We conducted a retrospective cohort study at a tertiary referral pediatric center of patients with MMA aged ≤18 years, who underwent general anesthesia for nonrevascularization procedures between January 2014 and July 2023. Postanesthesia NAEs were defined as occurrence of transient ischemic attacks, seizures, altered mental status, severe headache, or evidence of arterial ischemic stroke (AIS) in the 30 days postprocedure.

Results

Among 149 procedures on 38 patients (median age [interquartile range]: 8.3 [5.0, 12.7] years; 57% female), 124 (83.2%) procedures were imaging studies and angiographies and 25 (16.8%) were surgical procedures. Preprocedural hyperhydration treatment was administered before most (111, 74.5%) procedures per our institutional protocol. The incidence of postanesthesia NAEs was 0.67% (one of 149), as a result of acute AIS following a ventriculoperitoneal shunt revision surgery, in a patient with postradiation MMA, panhypopituitarism, and uncontrolled diabetes insipidus, despite preprocedural hyperhydration treatment. There were no NAEs after imaging studies performed under general anesthesia.

Conclusions

Our results suggest that general anesthesia for nonrevascularization procedures in pediatric patients with MMA prepared with hyperhydration is safe. As neuroradiological follow-up is central in children with MMA, this information can be valuable for reassuring patients and their families.

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来源期刊

Pediatric neurology 医学-临床神经学

CiteScore

4.80

自引率

2.60%

发文量

176

审稿时长

78 days

期刊介绍： Pediatric Neurology publishes timely peer-reviewed clinical and research articles covering all aspects of the developing nervous system. Pediatric Neurology features up-to-the-minute publication of the latest advances in the diagnosis, management, and treatment of pediatric neurologic disorders. The journal''s editor, E. Steve Roach, in conjunction with the team of Associate Editors, heads an internationally recognized editorial board, ensuring the most authoritative and extensive coverage of the field. Among the topics covered are: epilepsy, mitochondrial diseases, congenital malformations, chromosomopathies, peripheral neuropathies, perinatal and childhood stroke, cerebral palsy, as well as other diseases affecting the developing nervous system.