Cerebral Oximetry-Guided Anesthetic Management for Robot-Assisted Beating-Heart Coronary Artery Bypass Grafting in a Patient With Untreated Moyamoya Disease.

INTRODUCTION

Moyamoya disease is characterized by progressive stenosis of the internal carotid arteries and impaired cerebrovascular autoregulation, posing substantial challenges during cardiac surgery. Although coronary artery bypass grafting (CABG) has been reported in patients with moyamoya disease, anesthetic management during robot-assisted beating-heart CABG has not been reported.

CASE PRESENTATION: A 44-year-old woman with untreated moyamoya disease underwent robot-assisted coronary artery bypass grafting (RACABG) for left anterior descending artery disease. One-lung ventilation with intrathoracic carbon dioxide insufflation was required. Intraoperative anesthetic management was guided by regional cerebral oxygen saturation (rSO2) monitoring to ensure adequate cerebral perfusion. Strict control of blood pressure and arterial partial pressure of carbon dioxide allowed cerebral oxygenation to be maintained within 20% of baseline throughout surgery. The patient was extubated without any neurological deficits. On Postoperative Day 4, the patient developed sudden cardiac arrest, most likely due to coronary artery spasm, which lasted for approximately 19 min. She recovered fully without neurological impairment after cardiopulmonary resuscitation and percutaneous ventricular assist support.

CONCLUSIONS

This case highlights the usefulness of rSO2-guided anesthetic management with strict hemodynamic and carbon dioxide control during RACABG in patients with moyamoya disease. Vigilance for perioperative coronary vasospasm is essential in this population.