**2. Perioperative anesthetic consideration for revascularization or intracranial bypass surgery**

Anesthetic considerations for patients with MMD have been described in many literatures for both adult and pediatric populations [12–19]. Significant hemodynamic changes are expected throughout the perioperative period, and thus, it necessitates intensive care management. Hypertension and hypoventilation can potentially result in intracranial hemorrhage, likewise, intraoperative hypotension and hyperventilation can cause cerebral ischemia. The principles of safe anesthesia in neurosurgery, such as normotension, normocarbia, adequate oxygenation, normothermia, and normovolemia, are also applicable in revascularization surgery for patients with MMD. The anesthetic management of MMD presents unique challenges, as it can ensue further complications of the disease. Therefore, in-depth knowledge of pathophysiology and institutional guidelines for intraoperative optimal care of MMD patients improves perioperative care and long term outcomes [14, 17, 20]. Most of the following discussion highlights general anesthetic consideration in MMD (see **Table 3**).


**Table 3.**

*Perioperative considerations for revascularization surgery.*
