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    Anesthesia For Awake Craniotomy

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    Ahmad Naquiyuddin Bin Zaki
    Anesthesia for awake craniotomy allows patients to remain conscious during brain mapping to minimize neurological deficits from tumor resection. Benefits include reduced hospital stay and recovery time. The anesthetic aims to provide conscious sedation or asleep-awake-asleep periods using short-acting drugs like propofol and remifentanil to allow smooth transitions between states. Careful airway management and monitoring are needed due to the challenges of maintaining an unsecured airway during electrocautery.

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    Anesthesia For Awake Craniotomy

    Uploaded by

    Ahmad Naquiyuddin Bin Zaki
    49 views13 pages
    Anesthesia for awake craniotomy allows patients to remain conscious during brain mapping to minimize neurological deficits from tumor resection. Benefits include reduced hospital stay and recovery time. The anesthetic aims to provide conscious sedation or asleep-awake-asleep periods using short-acting drugs like propofol and remifentanil to allow smooth transitions between states. Careful airway management and monitoring are needed due to the challenges of maintaining an unsecured airway during electrocautery.

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    preparation for awake craniotomy

    Original Title

    ANESTHESIA FOR AWAKE CRANIOTOMY

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    Anesthesia for awake craniotomy allows patients to remain conscious during brain mapping to minimize neurological deficits from tumor resection. Benefits include reduced hospital stay and recovery time. The anesthetic aims to provide conscious sedation or asleep-awake-asleep periods using short-acting drugs like propofol and remifentanil to allow smooth transitions between states. Careful airway management and monitoring are needed due to the challenges of maintaining an unsecured airway during electrocautery.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    49 views13 pages

    Anesthesia For Awake Craniotomy

    Uploaded by

    Ahmad Naquiyuddin Bin Zaki
    Anesthesia for awake craniotomy allows patients to remain conscious during brain mapping to minimize neurological deficits from tumor resection. Benefits include reduced hospital stay and recovery time. The anesthetic aims to provide conscious sedation or asleep-awake-asleep periods using short-acting drugs like propofol and remifentanil to allow smooth transitions between states. Careful airway management and monitoring are needed due to the challenges of maintaining an unsecured airway during electrocautery.

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    ANESTHESIA FOR

    AWAKE CRANIOTOMY
    Introduction

     Allows mapping for resection of brain tumors near eloquent regions.


     Patient needs to be conscious and cooperative during testing.
     Benefits:
     Reduce length of stay
     Enhanced recovery
     Avoid risk of general anesthesia
     Reduce intensive care unit admissions
     Reduce resource utilization
    Indications

     Functional cortical mapping of eloquent brain function.


     Enable tailored resection. To maximize extent of tumor resection and minimize the
    risk of neurological deficit
     Electrophysiological mapping and recording.
     Localization of seizure foci. Minimize pharmacological interference.
     Improving perioperative outcomes.
     e.g. stereotactic biopsy, ventriculostomy, resection of supratentorial tumors.
    Preoperative Management

     Preoperative history and physical exam.


     Preoperative airway evaluation.
     Limited access and options.
     Well-motivated, mature and cooperative patients.
     Contraindications:
     Patient’s refusal
     Severe claustrophobia
     High blood loss
     Anxiety disorder, emotional instability
     Confusion or somnolence
     Alcohol or drug abuse
     Chronic pain disorders
     Low pain tolerance
     Morbid obesity
     Obstructive sleep apnea
     Anticipated difficult airway
     Uncontrolled coughing
     Dyspnea when lying flat
     Avoid benzodiazepines.
     Continuation of antiepileptic drugs.
     Patient preparation.
    Anesthetic Management

     Premedication
     Based on patient’s level of anxiety, neurologic status, comorbidities and plan.
     Monitoring
     Standard ASA (ECG, BP, pulse oximetry, O2 analyzer ETCO2 analyzer), processed
    EEG, intraarterial catheter, CBD.
     Positioning
     Supine, semi sitting or lateral.
     Avoid extreme flexion and rotation of the head.
     Patient’s comfort is important.
     Local anesthesia
     Local infiltration at incision and pin site
     Scalp block (6 nerves)
     Use long acting LA (Bupivacaine, Levobupivacaine, Ropivacaine)
     Monitor for systemic LA toxicity.
     Pain during procedure despite adequate block.
     Manipulation of dura and dissection of temporalis muscle.

     Anesthetic technique choice


     Asleep – awake – asleep
     Asleep – awake
     Conscious sedation
    Conscious sedation

     Aim for moderate sedation.


     Patient should respond purposefully to stimulation.
     Maintain airway, ventilation adequacy and hemodynamics stability.
     Avoid excessive sedation.
     Choice of medication:
     Avoid benzodiazepines.
     Propofol and remifentanil infusions allow for rapid titration of sedation depth.
     Dexmedetomidine to avoid respiratory depression and electrocorticography
    interference.
    Asleep Awake Asleep

     Induced with general anesthesia.


     Airway secured with ETT or supraglottic airway.
     Patient awakened once dura is open.
     General anesthesia induced again after mapping is complete.
     Choice of anesthetic agents:
     Hemodynamically stable.
     Allow for smooth transition to awake state.
     Propofol infusion with short acting opioids (e.g. remifentanil)
     Inhalational anesthesia
    Airway Management

     Intubation, supraglottic airway and supplemental oxygen.


     Supraglottic airway facilitate smoother transition.
     Airway manipulation during transition may cause coughing or spasm.
     Reestablishment of airway control is challenging.
     Administration of supplemental oxygen from unsecured airway increase the
    risk of airway fire from electrocautery.
    Postoperative Care

     Postoperative disposition is institution specific.


     Routine ICU admissions not needed, and indicated for patients with significant
    comorbidities or surgical complications.
     Extended PACU care followed by inpatient bed or same day discharge
    possible.
     Monitor for postoperative neurologic deficits, seizures.
     Treat pain, nausea and vomiting.

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