Anesthesia for Awake Craniotomy; a Case Report
Anestezi Dergisi, cilt.31, ss.145-147, 2023 (Scopus, TRDizin)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 31
- Basım Tarihi: 2023
- Dergi Adı: Anestezi Dergisi
- Derginin Tarandığı İndeksler: Scopus, Academic Search Premier, Central & Eastern European Academic Source (CEEAS), EMBASE, TR DİZİN (ULAKBİM)
- Sayfa Sayıları: ss.145-147
- Anahtar Kelimeler: Awake craniotomy, bispectral index, monitored anesthesia care, neurosurgery, scalp block
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background: Awake craniotomy is a neurosurgical intervention used for identifying and preserving the functional brain areas during resection of tumors, epilepsy and functional neurosurgery located near the cortical and subcortical language centers, sensory and motor pathways. Commonly used sedation techniques for an awake craniotomy include monitored anesthesia care and asleep-awake-asleep technique. We aim to present our experince of awake craniotomy under monitored anesthesia care. Case: 54 years old male patient with a parietal subcortical tumour was scheduled for surgical treatment. After a detailed preoperative evaluation, a written consent was taken for awake craniotomy. The patient was conscious, full cooperated and oriented without any motor deficits. The patient was monitored for electrocardiography, periferal oxygen saturation, invasive arterial blood pressure, end-tidal carbon dioxide and bispectral index in the operating room. Oxygen was delivered via a face mask. Intravenous infusions of propofol and remlfentanil were used for monitored anesthesia care. Bispectral index was maintained between 60 and 80. Bilateral scalp block was performed with epinephrine added 0.25 % bupivacaine and 1 % prilocain combination 15 minutes before skull pinning. The surgical procedure was performed in supine position under intraoperative navigation and neurophysiologlcal monitoring. Bupivacaine was also administered before durai incision. The patient was awakened intraoperative^ during the manuplation of motor cortex. He was able to move the left upper and lower extremities with verbal commands. After the resection, the patient was sedated until the end of the surgery. The surgical procedure proceeded without any complications. The patient was transferred to the intensive care unit after the surgery and monitored for postoperative complications. The patient was discharged on the fifth day of hospitalization. Conclusion: A careful and adequate selection and preparation of patient are mandatory. Several anesthetic tecniques are available for awake craniotomy. The choice of tecnique depends on the patient's characteristics, location and duration of the surgery and the experience of the anesthesiologist. Monitored anesthesia care presents an unprotected airway where asleep-awake-asleep technique provides a partially or totally protected airway. A propofol and remifentanil combination with bilateral scalp block provided adequate analgesia and effective monitored anaesthesia care for our patient.