Sevoflurane and Hyperperfusion Syndrome

Study Overview
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Brief Summary
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The aim of the present study is to evaluate the effect of sevoflurane postconditioning on the incidence of postoperative hyperperfusion syndrome following revascularization surgery in moyamoya patients.

Detailed Description
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Postoperative hyperperfusion syndrome is a common complication in moyamoya disease patients receiving revascularization surgery. Previously its incidence has been reported to be 17 50%, but little remains regarding frequency of reperfusion injury after revascularization surgery in patients with moyamoya disease. Volatile anesthetics such as sevoflurane has been introduced clinically to reduce reperfusion injury and preconditioning with sevoflurane induced ischemic tolerance like as ischemic preconditioning. However, there was no report on the neuroprotective effect of sevoflurane postconditioning on ischemic/reperfusion injury in human brain. Therefore, We evaluated the neuroprotective effect of sevoflurane postconditioning on the incidence of postoperative hyperperfusion syndrome after revascularization surgery in moyamoya disease patients.

Official Title
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Effect of Sevoflurane-induced Postconditioning on the Incidence of Postoperative Cerebral Hyperperfusion Syndrome After Revascularization Surgery in Adult Patients With Moyamoya Disease

Conditions
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Hyperperfusion Syndrome, Moyamoya Disease

Intervention / Treatment
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* Drug: Sevoflurane


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients receiving cerebral revascularization surgery due to moyamoya disease Exclusion Criteria: Patients who do not agree to the study Patients with uncontrolled diabetes or hypertension Patients using cyclooxygenase2 inhibitor or with previously using cyclooxygenase2 inhibitor Patients with acute renal failure Patients with previous intervention related with moyamoya disease

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Sevo_postconditioning<br>Patients receiving sevoflurane 1.0 minimum alveolar concentration (MAC) for 30 minutes after revascularization competed. | Drug: Sevoflurane<br>* administer 1.0 MAC (1.7 2.0 vol%) of sevoflurane for 30 minutes after vascular anastomosis completed<br>* Other names: Sevorane;|
| No Intervention: Non_postconditioning<br>Patients not receiving sevoflurane postconditioning after revascularization completed | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The incidence of postoperative cerebral hyperperfusion syndrome | Cerebral hyperperfusion syndrome was defined if all the following four criteria were met: i) new development of postoperative focal neurological deficits, ii) a delayed neurological deficits which were not shown in the immediate postoperative period; iii) postoperative reversible neurological deficits which were completely resolved within 15 days after operation; iii) neither definite haematomas nor definite acute infarction on a brain CT scan, on diffusion magnetic resonance imaging, or both. | postoperative day 15 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The incidence of a new onset postoperative cerebral ischemia | cerebral ischemia is diagnosed by clinical symptoms and radiologic imaging (CT or MRI). | participants will be followed for the duration of hospital stay, an expected average of 3 weeks. | 
| The incidence of a new onset postoperative brain hematoma | postoperative brain hematoma is diagnosed by clinical symptoms and radiologic imaging (CT or MRI). | participants will be followed for the duration of hospital stay, an expected average of 3 weeks. | 
| The incidence of unrecovered neurological deficit | the incidence of postoperative neurological symptoms which persisted or not fully recovered until the patient's discharge. | participants will be followed for the duration of hospital stay, an expected average of 3 weeks. |