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document
Effect of preoperative skull block on pediatric moyamoya disease . OBJECT 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 .
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Intervention_Surgical
encephaloduroarteriomyosynangiosis ( EDAMS )
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Intervention_Surgical
EDAMS surgery
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Intervention_Physical
NB
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Intervention_Pharmacological
bupivacaine
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Intervention_Pharmacological
methylprednisolone
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Intervention_Pharmacological
sevoflurane
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Outcome_Physical
hemodynamic fluctuations and hypo- or hyperventilation
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Outcome_Other
postoperative morbidity .
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Outcome_Physical
stable hemodynamic parameters
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Outcome_Physical
delirious awakening
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Outcome_Pain
Pain
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Outcome_Physical
analgesic requirement
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Outcome_Physical
arterial CO ( 2 ) tension in the postanesthesia care unit
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Outcome_Physical
rate of morbidity ( cerebral infarction and reversible ischemic neurological deficits )
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Outcome_Physical
hemodynamic control , calm awakening
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Outcome_Pain
pain relief
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Outcome_Other
postoperative morbidity
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Participant_Condition
moyamoya disease
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Participant_Age
pediatric
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Participant_Condition
moyamoya disease
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Participant_Age
Pediatric
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Participant_Age
age 3-13 years
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Participant_Condition
EDAMS surgery
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Participant_Condition
moyamoya disease
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Participant_Sample-size
18
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Participant_Sample-size
21