RecruitingNot ApplicableNCT07304947

Cardiac Index-Guided Intraoperative Hemodynamic Management in Pediatric Moyamoya Surgery

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

Sponsor

Seoul National University Hospital

Enrollment

94 participants

Start Date

Dec 2, 2025

Study Type

INTERVENTIONAL

Conditions

Moyamoya Disease

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

Min Age: 1 MonthMax Age: 18 Years

Inclusion Criteria1

Pediatric patients <18 years undergoing EDAS for Moyamoya disease under general anesthesia

Exclusion Criteria4

ASA physical status 4-5
Emergency surgery
Known cardiovascular disease
Any condition judged inappropriate by investigators

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Interventions

PROCEDURECardiac 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.

PROCEDUREBlood 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.