Effect of Sevoflurane Postconditioning on the Incidence of Symptomatic Cerebral Hyperperfusion after Revascularization Surgery in Adult Patients with Moyamoya Disease.

OBJECTIVE: Various experimental studies reported neuroprotective effects of sevoflurane postconditioning against cerebral ischemia-reperfusion injury. We thus investigated its neuroprotective effects on hyperperfusion-related transient neurologic deterioration, called symptomatic cerebral hyperperfusion (SCH) and also identified predictive factors for SCH in moyamoya patients after revascularization surgery.

METHODS: 152 adult moyamoya patients undergoing anastomosis of superficial temporal artery to middle cerebral artery were randomly allocated into two groups. Postconditioning group (group S, n=76) inhaled sevoflurane of 1 minimum alveolar concentration for 15 min immediately after reperfusion and then washed it out slowly for 15 min. Control group (group C, n=76) received no intervention. The incidence of SCH was compared between the two groups.

RESULTS: The incidence of SCH was not significantly different between groups S and C (53.3 vs 43.4%; P=0.291). The incidence of postoperative complications and the Glasgow Outcome Scale at hospital discharge also did not differ significantly. Predictive factors for SCH included a decreased vascular reserve in preoperative single-photon emission computed tomography (odds ratio [OR], 7.18; 95% confidence interval [95% CI], 1.78-29.02; P=0.006), an operation performed on the dominant hemisphere (OR, 3.32; 95% CI, 1.57-6.98; P=0.002), temporal occlusion time (OR, 1.06; 95% CI, 1.01-1.11; P=0.017), and intraoperative minimum partial pressure of carbon dioxide (Pa CO2 ; OR, 0.86; 95% CI, 0.78-0.94; P=0.001).

CONCLUSIONS: Sevoflurane postconditioning did not reduce the incidence of SCH after revascularization surgery in moyamoya patients. Rather, a decreased vascular reserve, operation on the dominant hemisphere, increased temporal occlusion time, and decreased intraoperative minimum Pa CO2 were associated with SCH in such patients.