A 10 year-old female with NF-1 and moyamoya is scheduled for cerebral angiography for preoperative staging and evaluation for a potential pial synangiosis. Which of the following blood pressures would be the most reasonable target during the procedure?
a) 80/40
b) 100/60
c) 120/80
d) 140/90
e) Cannot answer without more information
Answer e. The goal of management for patients with moyamoya is maintenance of blood pressure as close as possible to the patient’s baseline (awake) blood pressure; this usually requires a vasopressor infusion. In some cases, patients are known to develop symptoms (e.g., limb weakness) when hypotension below a certain level occurs; this is very helpful for the anesthesiologist and should be discussed with the primary neurologist preoperatively. Without knowledge of this patient’s baseline blood pressure, it is impossible to guess what the “best” intraoperative blood pressure will be.