Anesthesia Approaches and Key Considerations for Moyamoya Surgery

Understanding Anesthesia in Moyamoya Disease Surgery

Patients undergoing surgery for Moyamoya disease typically require general anesthesia with endotracheal intubation. This approach ensures airway protection, stable ventilation, and optimal surgical conditions during the delicate cerebrovascular procedures involved. General anesthesia allows precise control over the patient's physiological parameters, which is crucial given the sensitive nature of brain blood flow regulation in individuals with this condition.

Essential Preoperative Preparations

1. Gastrointestinal Preparation
To minimize the risk of aspiration during intubation, patients must fast from food and liquids for a recommended period before surgery—usually 6–8 hours for solids and 2 hours for clear fluids. In certain cases, especially when bowel preparation is advised, a cleansing enema may be administered preoperatively to reduce abdominal distension and further lower the chance of vomiting under anesthesia.

2. Psychological Readiness and Emotional Support
Surgical anxiety is common and can impact heart rate and blood pressure. Providing thorough preoperative counseling, explaining the anesthesia process, and offering reassurance can significantly reduce stress levels. Many medical centers now include psychological support or relaxation techniques such as guided breathing or mindfulness to help patients remain calm before entering the operating room.

Comprehensive Medical Evaluation Before Surgery

A full set of preoperative tests is essential to assess surgical eligibility and optimize patient safety. These include advanced imaging studies such as MRI, MRA, or cerebral angiography to evaluate the extent of vascular abnormalities. Blood work—including complete blood count, coagulation profile, electrolytes, and metabolic panels—helps identify any underlying conditions that could complicate anesthesia or recovery. Any contraindications, such as uncontrolled infections or severe cardiac issues, must be addressed prior to proceeding.

Practical Steps on the Day of Surgery

Prior to entering the operating theater, patients should remove all jewelry, watches, contact lenses, and removable dental appliances (dentures). These items can interfere with monitoring equipment, pose a choking hazard, or become dislodged during anesthesia. Wearing a hospital gown and clearly labeling personal belongings helps streamline the process and enhances patient safety.

Optimizing Vital Health Parameters

Controlling blood pressure and blood glucose levels before surgery is critical. Hypertension can increase the risk of intraoperative bleeding or stroke, while hypoglycemia or hyperglycemia may impair neurological recovery. Anesthesiologists often collaborate with internal medicine specialists to stabilize these metrics in the days leading up to the procedure, ensuring the patient enters surgery in the best possible physiological state.

Postoperative Care and Prevention of Complications

After surgery, vigilant monitoring in a specialized recovery unit—often an intensive care setting—is necessary. Nurses and doctors closely observe neurological status, vital signs, and fluid balance. Preventing postoperative complications such as deep vein thrombosis (DVT) and pulmonary infections is a top priority. Early mobilization, compression stockings, prophylactic anticoagulation (when appropriate), and respiratory exercises like incentive spirometry are commonly employed strategies.

In addition, maintaining adequate hydration and managing pain effectively without oversedation supports faster recovery and reduces the likelihood of respiratory depression. Multidisciplinary follow-up involving neurology, anesthesia, and rehabilitation teams ensures a smooth transition from hospital care to long-term management.