BACKGROUND: Moyamoya disease, a rare chronic cerebrovascular disease with a fragile vascular network at the base of the brain, can cause ischemic or hemorrhagic strokes or seizures. Precise blood pressure control and adequate analgesia are important for patients with moyamoya disease to prevent neurological events such as ischemia and hemorrhage. This study aimed to compare the intraoperative mean arterial pressure of pregnant women with moyamoya disease according to the mode of anesthesia (general anesthesia versus spinal anesthesia) used during cesarean delivery. METHODS: We retrospectively reviewed the medical records of 87 cesarean deliveries in 74 patients who had been diagnosed with moyamoya disease before cesarean delivery. The primary outcome, intraoperative maximum mean arterial pressure during anesthesia, was compared according to the type of anesthesia administered (general versus spinal anesthesia). Other perioperative hemodynamic data (lowest mean arterial pressure, incidence of hypotension, vasopressor use, and antihypertensive agent use), maternal neurologic symptoms, neonatal outcomes (Apgar scores <7, ventilatory support, and intensive care unit admission), maternal and neonatal length of stay, postoperative pain scores, and rescue analgesic use were assessed as secondary outcomes. RESULTS: While the lowest blood pressure during anesthesia and incidence of hypotension did not differ between the 2 groups, the maximum mean arterial pressure during anesthesia was lower in the spinal anesthesia group than that in the general anesthesia group (104.8 ± 2.5 vs 122.0 ± 4.6; P = .002). Study data did not support the claim that maternal neurologic symptoms differ according to the type of anesthesia used (5.6% vs 9.3%; P = .628); all patients recovered without any sequelae. The postoperative pain scores were lower, and fewer rescue analgesics were used in the spinal anesthesia group than in the general anesthesia group. Other maternal and neonatal outcomes were not different between the 2 groups. CONCLUSIONS: Compared with general anesthesia, spinal anesthesia mitigated the maximum arterial blood pressure during cesarean delivery and improved postoperative pain in patients with moyamoya disease.

中文翻译：

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烟雾病孕妇剖宫产的脊髓麻醉与全身麻醉：一项回顾性观察研究

背景：烟雾病是一种罕见的慢性脑血管疾病，脑底部血管网络脆弱，可引起缺血性或出血性中风或癫痫发作。精确的血压控制和充分的镇痛对于烟雾病患者预防缺血和出血等神经系统事件非常重要。本研究旨在根据剖宫产期间使用的麻醉方式（全身麻醉与脊髓麻醉）比较患有烟雾病的孕妇的术中平均动脉压。方法：我们回顾性回顾了剖宫产前诊断为烟雾病的74例患者的87例剖宫产病历。主要结果，麻醉期间术中最大平均动脉压，根据施用的麻醉类型（全身麻醉与脊髓麻醉）进行比较。其他围手术期血流动力学数据（最低平均动脉压、低血压发生率、血管加压药使用和抗高血压药物使用）、母体神经系统症状、新生儿结局（Apgar 评分 <7、通气支持和重症监护病房入院）、母婴长度住院时间、术后疼痛评分和抢救镇痛药的使用被评估为次要结局。结果：虽然两组麻醉期间最低血压和低血压发生率无差异，但腰麻组麻醉期间最大平均动脉压低于全麻组（104.8±2.5 vs 122.0±4.6）。 ; P = .002)。研究数据不支持母体神经系统症状因使用的麻醉类型而异的说法（5.6% vs 9.3%；P = .628）；所有患者都康复了，没有任何后遗症。与全麻组相比，腰麻组术后​​疼痛评分较低，使用的抢救性镇痛药较少。两组的其他孕产妇和新生儿结局没有差异。结论：与全身麻醉相比，腰麻可降低剖宫产时的最大动脉血压，改善烟雾病患者的术后疼痛。与全麻组相比，腰麻组使用的抢救性镇痛药较少。两组的其他孕产妇和新生儿结局没有差异。结论：与全身麻醉相比，腰麻可降低剖宫产时的最大动脉血压，改善烟雾病患者的术后疼痛。与全麻组相比，腰麻组使用的抢救性镇痛药较少。两组的其他孕产妇和新生儿结局没有差异。结论：与全身麻醉相比，腰麻可降低剖宫产时的最大动脉血压，改善烟雾病患者的术后疼痛。