Anesthetic Techniques for Awake Craniotomy: A Retrospective Review

Keywords

awake craniotomy - propofol - hemodynamics

Introduction: Awake craniotomy facilitates excision of brain tumors near the eloquent area and requires an awake, cooperative patient. Aim was to review the management for the awake craniotomy patients, perioperative complications, and compare the hemodynamics, neurological monitoring, and complications observed with intravenous infusions, that is, propofol and dexmedetomidine.

Methodology/Description: We retrospectively reviewed the charts of 51 patients who underwent awake craniotomy for tumor excision over past 6 years. Anesthesia management mainly the IV drug infusions and scalp block techniques, perioperative complications, and postoperative course was noted.

Results: Anesthesia was by propofol and dexmedetomidine infusion with scalp block. Hemodynamics were maintained better with dexmedetomidine infusion; only one had severe bradycardia which resolved with atropine. Propofol-induced desaturation was seen transiently in one patient for which jaw thrust was sufficient. Scalp block was either with bupivacaine 0.25% or inj. ropivacaine 0.2%. None of the patients required the conversion to general anesthesia. Brain bulge was seen only in one patient for which mannitol was administered. Three (5.8%) patients had intraoperative seizures with less incidence in propofol. Forty-two patients had positive localization on cortical stimulation, 23.5% had motor deficits, and 5.8% had aphasia intraoperatively. In one patient, there was propofol-induced neurological deficit which disappeared after stopping the infusion.

Conclusion: MAC with fentanyl, propofol, and dexmedetomidine is the technique of choice in our institute. Patients receiving dexmedetomidine had better hemodynamics but higher incidence of seizures. Propofol can help in the unmasking of the neurological deficits. Mapping of motor and language areas can alert the surgeon for proximity to the eloquent cortex and hence aid in careful tumor resection.

• References

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• 2 Chacko AG, Thomas SG, Babu KS. et al. Awake craniotomy and electrophysiological mapping for eloquent area tumours.. Clin Neurol Neurosurg 2013; 115 (03) 329-334