Browsing by Author "Stevanovic, Vesna (57193986276)"

Introduction: Moyamoya disease (MMD) is an arteriopathy characterized by progressive stenosis of brain arteries. Neurological symptoms can range from headaches and dizziness to severe sensory and motor impairment. Revascularization surgery helps prevent repeated strokes and further brain damage. Two postoperative years, age up to six years, and certain comorbidities are recognized as risk factors for complications during the process of brain neovascularization. Anesthetic management of these patients is challenging since anesthesia can alter cerebral blood flow (CBF) and cause inadequate perfusion in affected areas. Case Presentation: We report the case of a six-year-old boy with MMD who underwent deep sedation with sevoflurane for a follow-up endocranial MRI. In addition to MMD, the boy had a genetic predisposition for thrombosis, an allergy to atropine, and was within the critical two-year postoperative period during which any alterations in CBF could lead to complications. We chose sevoflurane and oxygen for deep sedation because of its favorable profile on hemodynamics and its negative feedback effect on respiratory drive, which prevents anesthetic overdose, enables spontaneous breathing, and preserves normocarbia during the procedure. The procedure lasted two hours and was uneventful. The boy was discharged home two hours later. Conclusions: Although revascularization surgery in MMD has a high success rate, in 5% of patients, repeated strokes can occur, especially in high-risk groups such as our patient. Awareness of existing risk factors, along with careful pre-anesthesia preparation and a well-considered anesthetic plan, are mandatory to prevent alterations in blood flow and ischemic attacks. © 2024, Mandras et al.

Background: Mechanical ventilation impairs oxygenation and increases intrapulmonary shunt. Positive end-expiratory pressure (PEEP) slows derecruitment, improves lung function but can compromise hemodynamics. Objectives: To asses slow PEEP titration effect on intrapulmonary shunt, oxygenation and hemodynamics in preschool children on mechanical ventilation under general anesthesia. Methods: This was a single tertiary care center an open-label, randomized parallel group controlled clinical trial. Study included 70 children, 3-7 years, ASA I and II, under general anesthesia for non-cardiothoracic surgery. Children were randomly allocated either to receive PEEP titration 5-11 cmH2O 20 minutes before the end of anesthesia (intervention group) or to be ventilated until the end of anesthesia with constant positive end-expiratory pressure of 3 cmH2O (control group). Main outcome measures were changes in oxygenation index (PaO2/FiO2) and alveolar-arterial gradient (P(A-a)O2) between and within groups and changes in systolic blood pressure (SBP), mean arterial pressure (MAP) and heart rate (HR) in interventional group during PEEP trial. Results: Seventy children were recruited and analyzed. P(A-a)O2 and PaO2/FiO2 improved in interventional group comparing to control as consequence of PEEP titration (∆PaO2/FiO2-30.3 vs. 0.52; P < 0.001; ∆P(A-a)O2 6.7 vs.-1.0; P < 0.001) and within interven-tional group before and after PEEP titration (PaO2/FiO2 522.0 vs. 552.3; P < 0.01; P(A-a)O2 20.1 vs. 13.3; P < 0.001). Hypotension and bradycardia were not documented. Conclusions: Slow PEEP titration up to 11 cmH2O improves oxygenation, reduces intrapulmonary shunt without causing hemodynamic instability in preschool children during general anesthesia. © 2019, Author(s).