Cardiac Index-Guided Intraoperative Hemodynamic Management in Pediatric Moyamoya Surgery

Condition(s) studied

Investigational drug(s) / intervention(s)

Cardiac Index-Guided Hemodynamic Management: In the experimental arm, intraoperative hemodynamic management is guided by each patient's baseline cardiac index. Cardiac output is continuously monitored using the LiDCO system after arterial line insertion. Baseline cardiac index is calibrated using transthoracic echocardiography, and intraoperative fluids and vasoactive agents are adjusted to maintain cardiac index within ±20% of baseline. Standard anesthesia monitoring is provided to all patients.

Blood Pressure-Guided Standard Hemodynamic Management: In the control arm, intraoperative hemodynamic management follows conventional blood pressure-guided practice. After arterial line placement, the LiDCO device remains connected but the display is concealed during anesthesia. Fluids and vasoactive medications are adjusted according to standard MAP-based management. Standard anesthesia monitoring is provided to all patients.

Study summary

This prospective randomized controlled trial evaluates whether individualized cardiac index-guided intraoperative hemodynamic management reduces postoperative transient ischemic episodes in pediatric patients undergoing encephaloduroarteriosynangiosis (EDAS) for Moyamoya disease. Patients are randomized 1:1 to goal-directed fluid therapy based on baseline cardiac index versus standard arterial pressure-based management. The primary outcome is the incidence of transient ischemic episodes during hospitalization.

Eligibility

Primary outcome measure(s)

• Incidence of transient ischemic episodes during hospitalization — Postoperative hospital stay
  From end of surgery through postoperative hospital discharge, up to 7 days

Trial sites (1)

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