Effect of preoperative skull block on pediatric moyamoya disease.
OBJECTIVE
Stable hemodynamics, normocapnia, and adequate pain relief are considered important factors in the reduction of neurological complications in pediatric patients undergoing encephaloduroarteriomyosynangiosis (EDAMS) operations for the treatment of moyamoya disease. A preoperative skull block may reduce hemodynamic fluctuations and hypo- or hyperventilation due to emergence delirium or oversedation and provide adequate pain relief, thereby reducing postoperative morbidity.


METHODS
Pediatric patients (age 3-13 years) undergoing EDAMS surgery for moyamoya disease were randomly divided into a nerve block (NB) group (18 cases) or control group (21 cases). The treatment group patients received a preoperative NB (0.25% 5-8 ml bupivacaine mixed with 20-40 mg methylprednisolone) targeting the supraorbital, supratrochlear, auriculotemporal, and posterior auricular nerves. Patients in the control group did not receive NB. General anesthesia with sevoflurane was induced in both groups.


RESULTS
In the NB group, stable hemodynamic parameters were obtained with a lower sevoflurane concentration than in the control group. For delirious awakening, the odds ratio in the control group was 4.9 compared with the NB group. Pain and analgesic requirement were higher in the control patients than in the NB-treated patients during the postanesthesia care unit stay. However, the arterial CO(2) tension in the postanesthesia care unit did not differ between the 2 groups. The odds ratio in the control group for the rate of morbidity (cerebral infarction and reversible ischemic neurological deficits) during the first 24 hours following the operation was 3.2 compared with the NB group.


CONCLUSIONS
The use of skull block during EDAMS surgery provided easy hemodynamic control, calm awakening, and better pain relief and may be related to the reduced postoperative morbidity.
Ahn
Hyun Joo
HJ
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Kangnam-Gu, Seoul, Korea. hyunjooahn@skku.edu
Kim
Jie Ae
JA
Lee
Jeong Jin
JJ
Kim
Han Soo
HS
Shin
Hyung Jin
HJ
Chung
Ik Soo
IS
Kim
Jin Kyoung
JK
Gwak
Mi Sook
MS
Choi
Soo Joo
SJ
D000293:Adolescent; D018685:Anesthetics, Inhalation; D002045:Bupivacaine / Q000008:administration & dosage; D002245:Carbon Dioxide / Q000097:blood; D002560:Cerebrovascular Circulation / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D003693:Delirium / Q000517:prevention & control; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008738:Methyl Ethers; D008775:Methylprednisolone / Q000008:administration & dosage; D009072:Moyamoya Disease / Q000601:surgery*; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control; D000077149:Sevoflurane; D012886:Skull / Q000294:innervation*
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D002245:Carbon Dioxide; D000077149:Sevoflurane; D008775:Methylprednisolone; D002045:Bupivacaine