Anaesthetic management of a parturient with moyamoya disease

Moyamoya disease is an uncommon progressive cerebral vasculopathy that is more frequently seen in the Asian population. It has been described sporadically in other parts of the world. Proper knowledge of the pathophysiology and institution of appropriate perioperative measures improves patient prognosis. We report a case of moyamoya disease for emergency Caesarean section at 37 weeks of gestation. Epidural anaesthesia was administered using 0.5 percent bupivacaine and 50 mu g fentanyl. A stable haemodynamic state was maintained using left lateral uterine displacement, intravenous crystalloids and ephedrine boluses. The patient suffered no neurological deficit and was discharged with a healthy baby four days after the surgery.