Hyperperfusion Syndrome, Moyamoya Disease
Conditions
Brief summary
The aim of the present study is to evaluate the effect of sevoflurane postconditioning on the incidence of postoperative hyperperfusion syndrome following revascularization surgery in moyamoya patients.
Detailed description
Postoperative hyperperfusion syndrome is a common complication in moyamoya disease patients receiving revascularization surgery. Previously its incidence has been reported to be 17\ 50%, but little remains regarding frequency of reperfusion injury after revascularization surgery in patients with moyamoya disease. Volatile anesthetics such as sevoflurane has been introduced clinically to reduce reperfusion injury and preconditioning with sevoflurane induced ischemic tolerance like as ischemic preconditioning. However, there was no report on the neuroprotective effect of sevoflurane postconditioning on ischemic/reperfusion injury in human brain. Therefore, We evaluated the neuroprotective effect of sevoflurane postconditioning on the incidence of postoperative hyperperfusion syndrome after revascularization surgery in moyamoya disease patients.
Interventions
DRUGSevoflurane
administer 1.0 MAC (1.7\ 2.0 vol%) of sevoflurane for 30 minutes after vascular anastomosis completed
Sponsors
Seoul National University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients receiving cerebral revascularization surgery due to moyamoya disease
Exclusion criteria
* Patients who do not agree to the study * Patients with uncontrolled diabetes or hypertension * Patients using cyclooxygenase2 inhibitor or with previously using cyclooxygenase2 inhibitor * Patients with acute renal failure * Patients with previous intervention related with moyamoya disease
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The incidence of postoperative cerebral hyperperfusion syndrome | postoperative day 15 | Cerebral hyperperfusion syndrome was defined if all the following four criteria were met: i) new development of postoperative focal neurological deficits, ii) a delayed neurological deficits which were not shown in the immediate postoperative period; iii) postoperative reversible neurological deficits which were completely resolved within 15 days after operation; iii) neither definite haematomas nor definite acute infarction on a brain CT scan, on diffusion magnetic resonance imaging, or both. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The incidence of a new onset postoperative cerebral ischemia | participants will be followed for the duration of hospital stay, an expected average of 3 weeks. | cerebral ischemia is diagnosed by clinical symptoms and radiologic imaging (CT or MRI). |
| The incidence of a new onset postoperative brain hematoma | participants will be followed for the duration of hospital stay, an expected average of 3 weeks. | postoperative brain hematoma is diagnosed by clinical symptoms and radiologic imaging (CT or MRI). |
| The incidence of unrecovered neurological deficit | participants will be followed for the duration of hospital stay, an expected average of 3 weeks. | the incidence of postoperative neurological symptoms which persisted or not fully recovered until the patient's discharge. |
Contacts
Primary ContactHee Pyung Park, MD, PhD
Backup ContactHyungseok Seo, MD
Outcome results
None listed