We described our management of a patient with
moyamoya disease who presented for emergency
cesarean section. A 29-year-old primigravida (162 cm, 61 kg) who had been diagnosed as having
moyamoya disease at age 24, underwent urgent
cesarean section at 35 weeks of gestation. Because she was medicated with
aspirin,
general anesthesia was selected.
Anesthesia was induced with
thiamylal and was maintained with
sevoflurane in air
oxygen mixture and
fentanyl before delivery. After delivery,
anesthesia was maintained with
midazolam and
fentanyl. Ventilation and depth of
anesthesia were adjusted according to the end-tidal
carbon dioxide tension and bispectral index, respectively.
Hypertension caused by tracheal intubation was successfully prevented by
nicardipine, which was ineffective for intraoperative
hypertension. On the other hand,
landiolol was effective for treating intraoperative
hypertension and
tachycardia. The cesarean delivery was uneventful and a healthy 2104 g neonate was delivered with Apgar score of 7 and 9 at 1 and 5 min, respectively.
Landiolol was effective for treating intraoperative
hypertension and
tachycardia. Monitoring of depth of
anesthesia, blood pressure, and ventilation would be essential for
cesarean section under
general anesthesia in patients with
moyamoya disease.