Anasthesia for awake craniotomy

Abstract

Awake craniotomy allows accurate localisation of cortical function, using superficial mapping, and is crucial during brain tumour resection in order to minimise the risk of neurologic injury. The role of the anaesthesiologist is to provide adequate analgesia and sedation while maintaining ventilation and haemodynamic stability in an awake patient who needs to be cooperative during neurological testing. We present the anaesthetic management that consists of two parts. During craniotomy, local anaesthesia is combined with deep sedation using 6-8 mg kg-1 h-1 propofol and 0.1 μg kg-1 min-1 remifentanil. Ventilation is maintained via a laryngeal tube. In the intracranial phase, sedation is discontinued, the laryngeal tube is removed, and the patients remain in logical contact with the surgeon and attending psychologists. After completion of the intracranial phase, sedation is reinstituted and the wound closed. The protocol, as described, was used in 53 patients, aged 40±13.4 years, for operations lasting 107±33.5 min. There were no major complications, however 15 patients had nausea and 23 complained of pain. Three patients did not tolerate awake surgery and anaesthesia was reinstituted. Awake craniotomy can be successfully performed under adequate anaesthetic conditions. It is a well-tolerated procedure with a low rate of complications. The benefits of maximal tumour excision can be achieved, leading to potentially better patient outcome. © PTAiIT, Borgis.