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Effect of Sevoflurane Postconditioning on the Incidence of Symptomatic Cerebral Hyperperfusion After Revascularization Surgery in Adult Patients with Moyamoya Disease.
- Source :
-
World Neurosurgery . Feb2020, Vol. 134, pe991-e1000. 10p. - Publication Year :
- 2020
-
Abstract
- Various experimental studies have reported neuroprotective effects of sevoflurane postconditioning against cerebral ischemia-reperfusion injury. We therefore investigated its neuroprotective effects on hyperperfusion-related transient neurologic deterioration, called symptomatic cerebral hyperperfusion (SCH), and also identified predictive factors for SCH in patients with moyamoya disease after revascularization surgery. A total of 152 adult patients with moyamoya disease undergoing anastomosis of the superficial temporal artery to middle cerebral artery were randomly allocated into 2 groups. The postconditioning group (group S, n = 76) inhaled sevoflurane of 1 minimum alveolar concentration for 15 minutes immediately after reperfusion and then washed it out slowly for 15 minutes. The control group (group C, n = 76) received no intervention. The incidence of SCH was compared between the 2 groups. The incidence of SCH was not significantly different between groups S and C (53.3% vs. 43.4%, respectively; P = 0.291). The incidence of postoperative complications and the Glasgow Outcome Scale score at hospital discharge also did not differ significantly. Predictive factors for SCH included a decreased vascular reserve in preoperative single-photon emission computed tomography scan (odds ratio [OR], 7.18; 95% confidence interval [CI], 1.78–29.02; P = 0.006), an operation performed on the dominant hemisphere (OR, 3.32; 95% CI, 1.57–6.98; P = 0.002), temporal occlusion time (OR, 1.06; 95% CI, 1.01–1.11; P = 0.017), and intraoperative minimum partial pressure of carbon dioxide (P a CO 2) (OR, 0.86; 95% CI, 0.78–0.94; P = 0.001). Sevoflurane postconditioning did not reduce the incidence of SCH after revascularization surgery in patients with moyamoya disease. Rather, a decreased vascular reserve, operation on the dominant hemisphere, increased temporal occlusion time, and decreased intraoperative minimum P a CO 2 were associated with SCH in these patients. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 18788750
- Volume :
- 134
- Database :
- Academic Search Index
- Journal :
- World Neurosurgery
- Publication Type :
- Academic Journal
- Accession number :
- 141683422
- Full Text :
- https://doi.org/10.1016/j.wneu.2019.11.055