After revascularization surgery in pediatric patients with moyamoya disease (MMD), resting and avoiding crying is important. However, this inaction is often difficult because of pain or anxiety. Dexmedetomidine (DEX), which has sedative and analgesic properties, may be useful in reducing those uncomfortable conditions; however, its common side effects include bradycardia and hypotension, which have a risk of decreasing the cerebral blood flow. The aim of this study was to investigate the efficacy and safety of using DEX for pediatric patients with MMD in the acute period after revascularization surgery.

This retrospective study included pediatric patients with MMD who underwent revascularization surgery. Based on whether DEX was used for light sedation during postoperative days (PODs) 0–1 after extubation, the patients were divided into DEX or control groups. For neurological outcomes, the incidence of symptomatic cerebral infarction and transient neurological events (TNEs) during PODs 0–1 and the entire hospitalization were investigated. In addition, the Richmond Agitation-Sedation Scale (RASS) was used to assess the effect of DEX, and bradycardia and hypotension were evaluated as side effects.

A total of 84 surgical procedures were included in this study (27 in the DEX group and 57 in the control group). During PODs 0–1, symptomatic infarction was not observed in either group. The incidence of TNEs was almost the same in both groups: 2 (7.4%) of the 27 procedures in the DEX group and 4 (7.0%) of the 57 procedures in the control group (p > 0.99). Moreover, the incidences of symptomatic infarction and TNEs during the entire hospitalization did not differ significantly (symptomatic infarction, p > 0.99; TNEs, p = 0.20). Regarding the DEX effect, the median RASS scores during PODs 0–1 were −1.0 (drowsy) in the DEX group and +1.0 (restless) in the control group, showing a significant difference (p < 0.01). Regarding side effects, bradycardia was observed only in 3 (11.1%) of the 27 procedures in the DEX group (p = 0.03), and hypotension was not observed in any of the cases.

In pediatric patients with MMD who are extubated after revascularization surgery, DEX produced appropriate light sedation and analgesia. The risk for symptomatic infarction is almost the same in cases in which DEX is used and those in which it is not; however, neurosurgeons should be cautious of bradycardia and TNEs as potential side effects.

烟雾病 (MMD) 儿科患者进行血运重建手术后，休息和避免哭泣很重要。然而，由于疼痛或焦虑，这种无所作为往往很困难。右美托咪定 (DEX) 具有镇静和镇痛作用，可能有助于减少这些不适症状；然而，其常见的副作用包括心动过缓和低血压，这些副作用有减少脑血流量的风险。本研究的目的是探讨在血运重建手术后急性期使用DEX治疗MMD儿科患者的疗效和安全性。

这项回顾性研究纳入了接受血运重建手术的 MMD 儿科患者。根据拔管后第0-1天（POD）是否使用DEX进行轻度镇静，将患者分为DEX组或对照组。对于神经系统结果，研究了 POD 0-1 期间和整个住院期间有症状的脑梗死和短暂性神经事件 (TNE) 的发生率。此外，使用里士满激动-镇静量表（RASS）评估DEX的效果，并评估心动过缓和低血压作为副作用。

本研究共纳入 84 例外科手术（DEX 组 27 例，对照组 57 例）。在 POD 0-1 期间，两组均未观察到有症状的梗塞。两组中 TNE 的发生率几乎相同：DEX 组 27 例手术中有 2 例（7.4%），对照组 57 例手术中有 4 例（7.0%）（p > 0.99）。此外，整个住院期间症状性梗死和 TNE 的发生率没有显着差异（症状性梗死，p > 0.99；TNE，p = 0.20）。关于 DEX 效应，POD 0-1 期间的中位 RASS 评分在 DEX 组中为 -1.0（困倦），在对照组中为 +1.0（焦躁），显示出显着差异（p < 0.01）。关于副作用，DEX 组 27 例手术中仅 3 例（11.1%）观察到心动过缓（p = 0.03），并且在所有病例中均未观察到低血压。

在血运重建手术后拔管的 MMD 儿科患者中，DEX 产生了适当的轻度镇静和镇痛作用。使用 DEX 和不使用 DEX 的情况下，出现症状性梗塞的风险几乎相同；然而，神经外科医生应警惕心动过缓和 TNE 等潜在副作用。