Perioperative Practices in Moyamoya Syndrome Revascularization: An International Transdisciplinary Survey
Background There are no evidence‐based resources guiding the perioperative management of patients with moyamoya syndrome who are undergoing revascularization surgery. We investigated practice patterns among a transdisciplinary group aiming at identifying possible heterogeneity of practices on key co...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-03-01
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| Series: | Stroke: Vascular and Interventional Neurology |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/SVIN.122.000521 |
| _version_ | 1827374780681027584 |
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| author | Melody Eckert Nilan Bhakta Scott A. Cohen Marc Alain Babi Mohammed Elghareeb Sebastian Gatica Michael A. Pizzi Steven A. Robicsek Christopher P. Robinson Matthew Koch Dimitri Laurent Arvin Trippensee Basma Mohamed Katharina M. Busl Carolina B. Maciel |
| author_facet | Melody Eckert Nilan Bhakta Scott A. Cohen Marc Alain Babi Mohammed Elghareeb Sebastian Gatica Michael A. Pizzi Steven A. Robicsek Christopher P. Robinson Matthew Koch Dimitri Laurent Arvin Trippensee Basma Mohamed Katharina M. Busl Carolina B. Maciel |
| author_sort | Melody Eckert |
| collection | DOAJ |
| description | Background There are no evidence‐based resources guiding the perioperative management of patients with moyamoya syndrome who are undergoing revascularization surgery. We investigated practice patterns among a transdisciplinary group aiming at identifying possible heterogeneity of practices on key components of care that warrant prospective studies. Methods We disseminated a web‐based Qualtrics survey internationally to physician members of the following: Neurocritical Care Society, Society of Critical Care Medicine, American Academy of Neurology, Society for Neuroscience in Anesthesiology and Critical Care, American Association of Neurological Surgeons, Asian Society of Neuroanesthesia and Critical Care, Indian Society of Neuroanesthesia and Critical Care, Japanese Society for Neuroscience in Anesthesiology and Critical Care, and World Federation of Neurosurgical Societies. The survey contained questions on demographics and aspects of preoperative, intraoperative, and postoperative care. Results Among the 175 physicians who managed at least 1 adult (aged ≥18 years) undergoing moyamoya revascularization in the preceding 24 months, 18 countries (United States, 84.6%) and 4 disciplines (anesthesiology [44.7%, 76/170], critical care medicine [30.6%, 52/170], neurology [32.4%, 55/170], and neurosurgery [15.3%, 26/170]) were represented. Anesthesiologists preferred total intravenous over volatile anesthesia (56.3%, 40/71 versus 42.3%, 30/71) and arterial line zeroing at the circle of Willis/tragus over the phlebostatic axis/right atrium intraoperatively (84.3%, 59/70 versus 11.4%, 8/70) and postoperatively (68.9%, 42/61 versus 24.6%, 15/61). Intraoperative blood pressure goals were primarily targeted to baseline blood pressure (34.8%, 48/138), whereas postoperative blood pressure goals were mainly determined by neurosurgeon preference (48.9%, 65/133). The predominant hemodynamic target was mean arterial pressure intraoperatively (50.4%, 68/135) and systolic blood pressure postoperatively (48.5%, 63/130). Crystalloid infusion was the preferred method to achieve perioperative hemodynamic goals (median rank, 1.0), followed by colloid infusion (median rank, 2.0) and phenylephrine (median rank, 2.0); however, colloid infusion and phenylephrine were considered contraindicated by 18.2% (10/55) and 20.0% (11/55), respectively. Conclusions We demonstrate perioperative practice heterogeneity for moyamoya syndrome revascularization among physicians for both methods and targets of hemodynamic management, constituting equipoise for prospective studies targeting optimal management strategies. |
| first_indexed | 2024-03-08T11:39:58Z |
| format | Article |
| id | doaj.art-f7d18392b5ff4d309482cbca8733d563 |
| institution | Directory Open Access Journal |
| issn | 2694-5746 |
| language | English |
| last_indexed | 2024-03-08T11:39:58Z |
| publishDate | 2023-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Stroke: Vascular and Interventional Neurology |
| spelling | doaj.art-f7d18392b5ff4d309482cbca8733d5632024-01-25T09:28:49ZengWileyStroke: Vascular and Interventional Neurology2694-57462023-03-013210.1161/SVIN.122.000521Perioperative Practices in Moyamoya Syndrome Revascularization: An International Transdisciplinary SurveyMelody Eckert0Nilan Bhakta1Scott A. Cohen2Marc Alain Babi3Mohammed Elghareeb4Sebastian Gatica5Michael A. Pizzi6Steven A. Robicsek7Christopher P. Robinson8Matthew Koch9Dimitri Laurent10Arvin Trippensee11Basma Mohamed12Katharina M. Busl13Carolina B. Maciel14University of Florida Gainesville FLUniversity of Texas Health Science Center at Houston Houston TXUniversity of Florida College of Medicine Gainesville FLDivision of Neurocritical Care Department of Neurology University of Florida College of Medicine Gainesville FLDepartment of Neurosurgery University of Florida College of Medicine Gainesville FLDepartment of Anesthesiology University of Florida College of Medicine Gainesville FLDivision of Neurocritical Care Department of Neurology University of Florida College of Medicine Gainesville FLDepartment of Anesthesiology University of Florida College of Medicine Gainesville FLDivision of Neurocritical Care Department of Neurology University of Florida College of Medicine Gainesville FLDepartment of Neurosurgery University of Florida College of Medicine Gainesville FLDepartment of Neurosurgery University of Florida College of Medicine Gainesville FLDepartment of Anesthesiology University of Florida College of Medicine Gainesville FLDepartment of Anesthesiology University of Florida College of Medicine Gainesville FLDivision of Neurocritical Care Department of Neurology University of Florida College of Medicine Gainesville FLDivision of Neurocritical Care Department of Neurology University of Florida College of Medicine Gainesville FLBackground There are no evidence‐based resources guiding the perioperative management of patients with moyamoya syndrome who are undergoing revascularization surgery. We investigated practice patterns among a transdisciplinary group aiming at identifying possible heterogeneity of practices on key components of care that warrant prospective studies. Methods We disseminated a web‐based Qualtrics survey internationally to physician members of the following: Neurocritical Care Society, Society of Critical Care Medicine, American Academy of Neurology, Society for Neuroscience in Anesthesiology and Critical Care, American Association of Neurological Surgeons, Asian Society of Neuroanesthesia and Critical Care, Indian Society of Neuroanesthesia and Critical Care, Japanese Society for Neuroscience in Anesthesiology and Critical Care, and World Federation of Neurosurgical Societies. The survey contained questions on demographics and aspects of preoperative, intraoperative, and postoperative care. Results Among the 175 physicians who managed at least 1 adult (aged ≥18 years) undergoing moyamoya revascularization in the preceding 24 months, 18 countries (United States, 84.6%) and 4 disciplines (anesthesiology [44.7%, 76/170], critical care medicine [30.6%, 52/170], neurology [32.4%, 55/170], and neurosurgery [15.3%, 26/170]) were represented. Anesthesiologists preferred total intravenous over volatile anesthesia (56.3%, 40/71 versus 42.3%, 30/71) and arterial line zeroing at the circle of Willis/tragus over the phlebostatic axis/right atrium intraoperatively (84.3%, 59/70 versus 11.4%, 8/70) and postoperatively (68.9%, 42/61 versus 24.6%, 15/61). Intraoperative blood pressure goals were primarily targeted to baseline blood pressure (34.8%, 48/138), whereas postoperative blood pressure goals were mainly determined by neurosurgeon preference (48.9%, 65/133). The predominant hemodynamic target was mean arterial pressure intraoperatively (50.4%, 68/135) and systolic blood pressure postoperatively (48.5%, 63/130). Crystalloid infusion was the preferred method to achieve perioperative hemodynamic goals (median rank, 1.0), followed by colloid infusion (median rank, 2.0) and phenylephrine (median rank, 2.0); however, colloid infusion and phenylephrine were considered contraindicated by 18.2% (10/55) and 20.0% (11/55), respectively. Conclusions We demonstrate perioperative practice heterogeneity for moyamoya syndrome revascularization among physicians for both methods and targets of hemodynamic management, constituting equipoise for prospective studies targeting optimal management strategies.https://www.ahajournals.org/doi/10.1161/SVIN.122.000521cerebral revascularizationhemodynamic monitoringmoyamoya diseasemoyamoya syndromeneurocritical careperioperative |
| spellingShingle | Melody Eckert Nilan Bhakta Scott A. Cohen Marc Alain Babi Mohammed Elghareeb Sebastian Gatica Michael A. Pizzi Steven A. Robicsek Christopher P. Robinson Matthew Koch Dimitri Laurent Arvin Trippensee Basma Mohamed Katharina M. Busl Carolina B. Maciel Perioperative Practices in Moyamoya Syndrome Revascularization: An International Transdisciplinary Survey Stroke: Vascular and Interventional Neurology cerebral revascularization hemodynamic monitoring moyamoya disease moyamoya syndrome neurocritical care perioperative |
| title | Perioperative Practices in Moyamoya Syndrome Revascularization: An International Transdisciplinary Survey |
| title_full | Perioperative Practices in Moyamoya Syndrome Revascularization: An International Transdisciplinary Survey |
| title_fullStr | Perioperative Practices in Moyamoya Syndrome Revascularization: An International Transdisciplinary Survey |
| title_full_unstemmed | Perioperative Practices in Moyamoya Syndrome Revascularization: An International Transdisciplinary Survey |
| title_short | Perioperative Practices in Moyamoya Syndrome Revascularization: An International Transdisciplinary Survey |
| title_sort | perioperative practices in moyamoya syndrome revascularization an international transdisciplinary survey |
| topic | cerebral revascularization hemodynamic monitoring moyamoya disease moyamoya syndrome neurocritical care perioperative |
| url | https://www.ahajournals.org/doi/10.1161/SVIN.122.000521 |
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