Personalized Cardiac Index-Guided Intraoperative Hemodynamic Management to Improve Postoperative Outcomes in Pediatric Patients With Moyamoya Disease: A Randomized Controlled Trial

What this Trial Is About

Researchers are evaluating whether a personalized cardiac index-guided approach to managing blood flow during surgery can reduce postoperative transient ischemic episodes in children undergoing encephaloduroarteriosynangiosis (EDAS) surgery for Moyamoya disease. This prospective randomized controlled trial compares this approach to the standard method of managing blood pressure during surgery. The study focuses on pediatric patients under general anesthesia and aims to improve postoperative outcomes. Participants are randomly assigned to one of two groups: one group receives intraoperative hemodynamic management guided by their baseline cardiac index, which is continuously monitored and adjusted to stay within 20% of their baseline using the LiDCO system and echocardiography. The other group receives standard blood pressure-guided management where fluids and medications are adjusted based on mean arterial pressure. Both groups receive standard anesthesia monitoring during surgery. Throughout their hospital stay, participants will be closely monitored for transient ischemic episodes and other complications using MRI scans, fluid and medication tracking, and assessments of anesthesia and ventilation duration. Researchers will measure outcomes such as postoperative cerebral infarction, intracranial hemorrhage, length of hospital and ICU stay, intraoperative blood loss, and deviations from baseline cardiac index and blood pressure. The study follow-up includes the postoperative hospital stay and up to 14 days in the ICU, allowing comprehensive evaluation of recovery and safety.

Cardiac Index-Guided Intraoperative Hemodynamic Management in Pediatric Moyamoya Surgery