Retrospective analysis of anaesthesia for awake craniotomy: A three year review of our institutional practice

Background: The awake craniotomy technique aims to maximize lesion resection while sparing functional areas of the brain (motor, somatosensory, and language areas). Different anaesthetic care protocols for awake craniotomy are advocated, however, there is still no consensus as to the best anesthetic technique. Our analysis aims to study the safety and efficacy of anaesthesia techniques and to conclude which technique provides the most optimal conditions for patient participation during awake surgery with least incidence of intra-op complications. Materials and Methods: Awake craniotomies performed during the period from January 1^st, 2011 to December 31^st, 2013 were included and cases with inadequate data were excluded. Data evaluated in terms of which anaesthesia technique maintained patient awake enough to provide comprehensive answers to questions asked during surgery, perform motor activities as advised, maintained haemodynamics within 20% of baseline, adjunct drugs used and incidence of intra-op complications. Results: Sixty three patients of 69 were included in the study- 90% of the patients did not require any adjuncts apart from scalp block during surgery. Additional infiltration by surgeon was required in 6% of patients. Propofol infusion was supplemented in 4% of patients and Dexmedetomidine in 9% of patients. One patient was done in awake-sleep-awake technique. Haemodynamics were maintained in all and no incidence of loss of airway was seen. Incidence of intra-op seizures was 5%. Conclusion: A scalp block with conscious sedation of the patient is best standard of care for awake craniotomies. Dexmedetomidine is an emerging as a safe adjunct, but larger prospective studies are required to advocate its routine use.

No conflict of interest has been declared by the author(s).

[Abstracts published in the Journal of Neuroanaesthesiology and Critical Care have not been reviewed by the Editorial Board of the Journal. These abstracts were presented at the annual meet of ISNACC and selected by the organizers and the scientific committee of the Society]