Anaesthetic management of neurosurgical patients

Innovative Neurosurgery, 2013

Objective: The generally used asleep-awake-asleep protocol makes reliable intra-operative testing difficult as patients are frequently disoriented when woken-up from sedation. Furthermore, this protocol carries potential risks for the patient, the most common among them being respiratory complications. In an effort to eliminate potential risks for the patient during awake craniotomies, and in order to improve reliability of intra-operative test results, we implemented a new protocol for awake craniotomies, the continuous awake craniotomy protocol, where the patient is not sedated during the entire procedure. We present first results of this new protocol. Methods: In a prospective study we analyzed awake craniotomies that were performed between September 2006 and June 2008. Data included OR-records, anesthesiological protocols, patient charts, and neuropsychological records. Results: Data of 12 consecutive primary brain tumor patients (six men/six women) with a mean age of 46 years who underwent 13 awake craniotomies were analyzed. A gross total resection was achieved in ten patients (83.3%), of which one patient (8.3%) suffered from a new neurological deficit postoperatively. One patient suffered a generalized seizure and one a focal seizure triggered by direct cortical stimulation. There were no anesthesiological or surgical complications in this study. Conclusion: This study shows that the continuous awake craniotomy protocol is safe, was tolerated well by all patients, and created a very controllable situation during all surgeries. Applying this method, sedation related complications, such as respiratory complications and hemodynamic dysregulation, can be avoided, as are potential risks during an intra-operative wake-up phase. Furthermore, intra-operative neuropsychological test results become more reliable.

Medicinski pregled, 2016

Introduction. There is an increasing trend towards performing awake craniotomy procedures. The method is indicated for surgical treatment of brain changes located in functional regions. This technique poses a unique challenge for the anaesthesiologist in view of providing adequate sedation, analgesia, hemodynamic and respiratory stability yet to keep the patient awake and cooperative during the procedure. Case Report. After the adequate preoperative preparation of the patient, the surgical procedure on tumorous change in the left frontoparietal area (Broca?s area) was performed. Due to the tumour localization, the surgical treatment was performed in awake condition under intraoperative neurophysiological monitoring of the patient. Analgosedation (Ramsay score 2-3) was provided via continuous infusion of propofol and reminfentanil. Local infiltration anaesthesia (scalp block) was preformed with levobupivacaine. The surgical procedure proceeded without any major incidents and complica...

Awake craniotomy is a surgical technique where the patient remains conscious during part or all of the brain surgery. This procedure is primarily used for the resection of tumors or epileptic foci in areas of the brain responsible for critical functions such as movement and language. By keeping the patient awake, the surgical team can perform real-time brain mapping, which allows for the preservation of essential neurological functions while maximizing tumor resection. The procedure requires careful patient selection, thorough preoperative counseling, and a coordinated effort by the interprofessional team to ensure its success. Awake craniotomies have evolved since their first use in 1886 and are now a cornerstone in neurosurgery for cases where preserving brain function is crucial.

Neurosurgical Focus, 2005

Neurosurg. Focus/Volume 18/April, 2005 1 findings in an unfortunate patient whose brain surface had been exposed by an ulcer. Electrical stimulation of the brain produced muscular contractions and paresthesias in the patient's contralateral arm and leg. 12 The ...

Journal of Neurosurgery, 2013

Object Awake craniotomy for removal of intraaxial tumors within or adjacent to eloquent brain regions is a well-established procedure. However, awake craniotomy failures have not been well characterized. In the present study, the authors aimed to analyze and assess the incidence and causes for failed awake craniotomy. Methods The database of awake craniotomies performed at Tel Aviv Medical Center between 2003 and 2010 was reviewed. Awake craniotomy was considered a failure if conversion to general anesthesia was required, or if adequate mapping or monitoring could not have been achieved. Results Of 488 patients undergoing awake craniotomy, 424 were identified as having complete medical, operative, and anesthesiology records. The awake craniotomies performed in 27 (6.4%) of these 424 patients were considered failures. The main causes of failure were lack of intraoperative communication with the patient (n = 18 [4.2%]) and/or intraoperative seizures (n = 9 [2.1%]). Preoperative mixed ...

Annals of the Academy of Medicine, Singapore, 2007

Awake craniotomy allows accurate localisation of the eloquent brain, which is crucial during brain tumour resection in order to minimise 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 reviewed the anaesthetic management of patients undergoing an awake craniotomy procedure. The records of all the patients who had an awake craniotomy at our institution from July 2004 till June 2006 were reviewed. The anaesthesia techniques and management were examined. The perioperative complications and the outcome of the patients were noted. There were 17 procedures carried out during the study period. Local anaesthesia with moderate to deep sedation was the technique used in all the patients. Respiratory complications occurred in 24% of the patients. Hypertension was observed in 24% of the patients. All t...

2018

This thesis aims to provide a solid framework of the anesthesiological aspects linked to an awake craniotomy procedure for brain tumor resection. To begin with, it should be clarified, that the term ‘anesthesiological’ in case of the awake craniotomy covers the whole non-operative/non-surgical context, including metabolic and psychological aspects, too - and not only sedation and analgesia. In summary, after the publication of this thesis, there remain a lot of unanswered questions and challenges for the patient undergoing and the team performing an awake craniotomy for brain tumor resection. There is no doubt, that all efforts must be taken, to make the procedure for the patient as safe, as effective, and as pleasant as possible. This is most probably warranted by an experienced and dedicated team, with intensive counselling of the patient – which is routine at Erasmus MC.

Signa Vitae, 2008

Resection of brain tumors may cause neurological sequelae, according to the site and size of the brain tissue removed. Awake craniotomy has been proposed as a surgical approach to satisfy criteria of radical surgery while minimizing eloquent brain damage. The most critical aspect of awake craniotomy is to maintain adequate patient comfort, analgesia, immobility and cooperation during a long surgical operation, ensuring in the meanwhile the safety, control and maintenance of vital functions. Apart from pharmacological, surgical, technical knowledge and skillfulness, the ability to maintain close psycho-emotional contact and support with the patient throughout the operation is a fundamental task that the anesthesiologist has to pursue for the operation to be successfully managed. This review summarizes the current opinion on anesthetic management of patients undergoing awake craniotomy.

Interdisciplinary Neurosurgery, 2020

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Awake craniotomy surgery is performed when a tumor lies near or close to functional areas, like motor and speech areas. During surgery cortical stimulation together with brain mapping is executed to clearly define the extent of the tumor boundaries as well as the area through which the lesion can be approached . Throughout this surgery the patient is awake and cooperative. This article gives the advantages of awake craniotomy performed in 7 patients in our hospital.