{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T05:09:58Z","timestamp":1790226598209,"version":"4.1.0"},"reference-count":11,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,2,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Perioperative stroke is a major complication of revascularization surgery in patients with moyamoya. Vomiting is common after neurosurgical procedures and may result in acute changes in intracranial pressure and cerebral blood flow. The authors instituted a standardized perioperative nausea and vomiting protocol for children with moyamoya undergoing indirect bypass surgery at their institution and analyzed its association with perioperative stroke. They hypothesized that instituting a standardized perioperative nausea and vomiting protocol would be associated with reduction in the number of perioperative strokes in children with moyamoya undergoing indirect bypass surgery.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors retrospectively reviewed consecutive cases of children and young adults with moyamoya who underwent indirect bypass surgery before and after implementation of a new perioperative nausea and vomiting protocol at a single institution. They compared the rate of strokes in the perioperative period (postoperative days 0 and 1) in the 31 months following implementation to 31 months prior to implementation using Fisher\u2019s exact test.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>The median ages pre- and postimplementation were 8.5 (IQR 4\u201312) years and 8.3 (IQR 5\u201315) years, respectively. There were no significant differences between the cohorts in disease severity or other potentially confounding factors. In the 31 months prior to initiation of the perioperative nausea and vomiting protocol, there were 5 strokes in 137 surgically treated hemispheres (3.6%). After initiation of the protocol, there were no strokes in 114 surgically treated hemispheres (p = 0.065).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Instituting a standardized perioperative nausea and vomiting protocol was associated with reduction in perioperative strokes in children with moyamoya treated with indirect bypass surgery.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.9.peds23313","type":"journal-article","created":{"date-parts":[[2023,11,18]],"date-time":"2023-11-18T02:16:26Z","timestamp":1700273786000},"page":"185-189","source":"Crossref","is-referenced-by-count":4,"title":["Prevention of postoperative stroke in pediatric moyamoya patients: a standardized perioperative care protocol"],"prefix":"10.3171","volume":"33","author":[{"given":"Jennifer","family":"Judge","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ari D.","family":"Kappel","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery"},{"name":"Department of Neurosurgery, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Isibor","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill E.","family":"O\u2019Hara","sequence":"additional","affiliation":[{"name":"Anesthesiology, Critical Care, and Pain Medicine; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Larson","sequence":"additional","affiliation":[{"name":"Anesthesiology, Critical Care, and Pain Medicine; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Kleinman","sequence":"additional","affiliation":[{"name":"Anesthesiology, Critical Care, and Pain Medicine; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred P.","family":"See","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura L.","family":"Lehman","sequence":"additional","affiliation":[{"name":"Neurology, Boston Children\u2019s Hospital; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward R.","family":"Smith","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Skull Base","first-page":"15","article-title":"Surgical management of moyamoya syndrome","volume":"15","author":"Smith ER","year":"2005","unstructured":"Smith ER, Scott RM. Surgical management of moyamoya syndrome. Skull Base. 2005;15(1):15\u201326."},{"issue":"2 Suppl Pediatrics","key":"b2","series-title":"J Neurosurg","first-page":"142","article-title":"Long-term outcome in children with moyamoya syndrome after cranial revascularization by pial synangiosis","volume":"100","author":"Scott RM","year":"2004","unstructured":"Scott RM, Smith JL, Robertson RL, Madsen JR, Soriano SG, Rockoff MA. Long-term outcome in children with moyamoya syndrome after cranial revascularization by pial synangiosis. J Neurosurg. 2004;100(2 Suppl Pediatrics):142\u2013149."},{"issue":"1","key":"b3","series-title":"Brain Commun","first-page":"fcz029","article-title":"Clinical status and evolution in moyamoya: which angiographic findings correlate?","volume":"1","author":"Rosi A","year":"2019","unstructured":"Rosi A, Riordan CP, Smith ER, Scott RM, Orbach DB. Clinical status and evolution in moyamoya: which angiographic findings correlate? Brain Commun. 2019;1(1):fcz029."},{"issue":"2","key":"b4","series-title":"J Neurosurg","first-page":"531","article-title":"Risk factors for and outcomes of postoperative complications in adult patients with moyamoya disease","volume":"130","author":"Zhao M","year":"2019","unstructured":"Zhao M, Deng X, Zhang D,  Risk factors for and outcomes of postoperative complications in adult patients with moyamoya disease. J Neurosurg. 2019;130(2):531\u2013542."},{"issue":"4","key":"b5","series-title":"J Neurosurg Pediatr","first-page":"420","article-title":"Pial synangiosis in patients with moyamoya younger than 2 years of age","volume":"13","author":"Jackson EM","year":"2014","unstructured":"Jackson EM, Lin N, Manjila S, Scott RM, Smith ER. Pial synangiosis in patients with moyamoya younger than 2 years of age. J Neurosurg Pediatr. 2014;13(4):420\u2013425."},{"issue":"12-14","key":"b6","series-title":"J Child Neurol","first-page":"963","article-title":"Risk factors and imaging biomarkers associated with perioperative stroke in pediatric moyamoya arteriopathy","volume":"37","author":"Gardner Yelton SE","year":"2022","unstructured":"Gardner Yelton SE, Gatti J, Adil M, Guryildirim M, Tekes A, Sun LR. Risk factors and imaging biomarkers associated with perioperative stroke in pediatric moyamoya arteriopathy. J Child Neurol. 2022;37(12-14):963\u2013969."},{"key":"b7","series-title":"World Neurosurg","first-page":"728","article-title":"Effect of aspirin in postoperative management of adult ischemic moyamoya disease","volume":"105","author":"Zhao Y","year":"2017","unstructured":"Zhao Y, Zhang Q, Zhang D, Zhao Y. Effect of aspirin in postoperative management of adult ischemic moyamoya disease. World Neurosurg. 2017;105:728\u2013731."},{"issue":"3","key":"b8","series-title":"J Neurosurg Pediatr","first-page":"289","article-title":"Preoperative transdural collateral vessels in moyamoya as radiographic biomarkers of disease","volume":"19","author":"Storey A","year":"2017","unstructured":"Storey A, Scott RM, Robertson R, Smith E. Preoperative transdural collateral vessels in moyamoya as radiographic biomarkers of disease. J Neurosurg Pediatr. 2017;19(3):289\u2013295."},{"issue":"4","key":"b9","series-title":"J Stroke Cerebrovasc Dis","first-page":"107029","article-title":"Practice variability in the perioperative management of pediatric moyamoya disease in North America","volume":"32","author":"Sun LR","year":"2023","unstructured":"Sun LR, Hersh DS, Smith ER, Aldana PR, Jordan LC. Practice variability in the perioperative management of pediatric moyamoya disease in North America. J Stroke Cerebrovasc Dis. 2023;32(4):107029."},{"issue":"5","key":"b10","series-title":"Indian J Anaesth","first-page":"454","article-title":"Basics of fluid and blood transfusion therapy in paediatric surgical patients","volume":"56","author":"Arya VK","year":"2012","unstructured":"Arya VK. Basics of fluid and blood transfusion therapy in paediatric surgical patients. Indian J Anaesth. 2012;56(5):454\u2013462."},{"key":"b11","series-title":"MIT Sloan Management Review","article-title":"Toyota\u2019s secret: the A3 report","author":"Shook J","unstructured":"Shook J. Toyota\u2019s secret: the A3 report. MIT Sloan Management Review. July 1, 2009.Accessed October 5, 2023.https:\/\/sloanreview.mit.edu\/article\/toyotas-secret-the-a3-report\/"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/33\/2\/article-p185.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/33\/2\/article-p185.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/33\/2\/article-p185.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T13:06:13Z","timestamp":1733490373000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/33\/2\/article-p185.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,1]]},"references-count":11,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2023.9.peds23313","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,1]]}}}