Descriptive Study: Anesthesia for Awake ￼Craniotomy in Siriraj Hospital
Authors: Saipin Muangman, M.D., Somkhuan Dechasilaruk, M.D., Walaiporn Punkla, M.D., Manee Raksakietisak, M.D., Pranee Rushatamukayanunt, M.D., Saowapark Chumpathong, M.D., Kamheang Vacharaksa, M.D., Suvit Soontarinka, M.D.
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Background: The purpose of awake craniotomy is to test neurological functions to ensure accurate lesion surgery and lessen postoperative neurological complications. There are several methods to provide anesthesia during awake craniotomy including local anesthesia infiltration, local anesthesia plus conscious sedation, general anesthesia and wake-up during surgery and sleep again (asleep-awake-asleep or AAA). Each method has its pro and con with different complications. In Siriraj Hospital, there was no prior study of anesthetic techniques and complications of awake craniotomy.
Methods: The retrospective descriptive study of awake craniotomy was carried out with 60 patients in Siriraj Hospital 2007-2011.
Results: There were 35 males (58.3%) with average age 40.7±12.6 years and weight 64.2±12 kilograms undergoing awake craniotomy. Twenty patients (33.3%) presented with seizure before surgery. Most diagnosis was oligodendroglioma in 25 patients (41.7%), mostly at the frontal lobe (44 patients or 73.3%). The most common position was supine (46 patients or 76.7%). ICU length of stay was 1.4±0.9 (0,6) days. Hospital stay was 11.1± 9 (4, 55) days. Total intravenous anesthesia (TIVA) was mostly used (52 patients or 90%) while 18 patients (30%) received scalp block. Most patients (85%) did not require nasal airways while 8 patients (13.3%) did, and only 1 patient (1.7%) required laryngeal mask airway (LMA) to help open up air passage. The drugs used during asleep1 and asleep2 were propofol together with dexmedetomidine and fentanyl in 34 patients (56.7%) and 23 patients (38.3%), respectively. While being awake (15 patients or 20%), dexmedetomidine and/or fentanyl were administered. Complications during anesthesia were hypertension (33.3%), hypotension (26.7%), upper airway obstruction (23.3%), bradycardia (15%), tachycardia (10%), seizure (1.7%) and nausea (1.7%).
Conclusion: The most common anesthesia method in Siriraj Hospital for awake craniotomy was TIVA (90%), using propofol together with dexmedetomidine and fentanyl. Only one patient (1.7%) received anesthesia via inhalation with LMA. Complications during anesthesia were mostly hypertension, hypotension and upper airway obstruction, respectively.