We report the anesthetic management of a 31-year-old female patient with moyamoya disease using general anesthesia combined with epidural anesthesia for a cesarean section due to placenta previa. Epidural anesthesia with 10 ml of 2% lidocaine was first used. Then general anesthesia was induced with thiamylal 200 mg and succinylcholine 60 mg just before starting operation and was maintained with 60% nitrous oxide in oxygen. After the delivery, propofol was administered at 3-5 mg.kg-1.hr-1. Except for temporary hypotension due to massive bleeding, systolic blood pressure was maintained between 100 and 120 mmHg. Arterial carbon dioxide tension was maintained at about 40 mmHg. Intracranial blood velocity and regional oxygen saturation were also measured to monitor cerebral blood flow. There was no postoperative pain, and no postoperative neurological defects. On the basis of these findings, it was concluded that general anesthesia combined with epidural anesthesia for elective cesarean section due to placenta previa is effective for perioperative management of a patient with moyamoya disease.
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