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Cerebrovascular autoregulation in pediatric moyamoya disease
Author(s) -
Lee Jennifer K.,
Williams Monica,
Jennings Jacky M.,
Jamrogowicz Jessica L.,
Larson Abby C.,
Jordan Lori C.,
Heitmiller Eugenie S.,
Hogue Charles W.,
Ahn Edward S.
Publication year - 2013
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.12140
Subject(s) - medicine , autoregulation , moyamoya disease , cerebral autoregulation , anesthesia , hemodynamics , cardiology , blood pressure , ischemia
Summary Background Moyamoya syndrome carries a high risk of cerebral ischemia, and impaired cerebrovascular autoregulation may play a critical role. Autoregulation indices derived from near‐infrared spectroscopy ( NIRS ) may clarify hemodynamic goals that conform to the limits of autoregulation. Objectives The aims of this pilot study were to determine whether the NIRS ‐derived indices could identify blood pressure ranges that optimize autoregulation and whether autoregulatory function differs between anatomic sides in patients with unilateral vasculopathy. Methods Pediatric patients undergoing indirect surgical revascularization for moyamoya were enrolled sequentially. NIRS ‐derived autoregulation indices, the cerebral oximetry index ( CO x) and the hemoglobin volume index ( HV x), were calculated intraoperatively and postoperatively to measure autoregulatory function. The 5‐mm H g ranges of optimal mean arterial blood pressure ( MAP OPT ) with best autoregulation and the lower limit of autoregulation ( LLA ) were identified. Results Of seven enrolled patients (aged 2–16 years), six had intraoperative and postoperative autoregulation monitoring and one had only intraoperative monitoring. Intraoperative MAP OPT was identified in six (86%) of seven patients with median values of 60–80 mm H g. Intraoperative LLA was identified in three (43%) patients with median values of 55–65 mm H g. Postoperative MAP OPT was identified in six (100%) of six patients with median values of 70–90 mmHg. Patients with unilateral disease had higher intraoperative HV x ( P = 0.012) on side vasculopathy. Conclusions NIRS ‐derived indices may identify hemodynamic goals that optimize autoregulation in pediatric moyamoya.