engleski

Awake Craniotomy–An Anesthesiologist Point of View

Background Monitored anesthesia care (MAC) is a well-established anesthetic technique for awake craniotomy, a complex neurosurgical and neuroanesthetic procedure that is becoming a standard of care for tumor resection in eloquent brain areas. Clinical Case Series During the past 2 years, we have successfully implemented awake craniotomy in Croatia, using MAC as anesthetic technique. Ten patients (age range: 32–64 years ; 6 males, 4 females) with tumor in eloquent area were operated, without surgical or anesthesiological complications. Patients were carefully selected by a multidisciplinary team consisting of neurosurgeons, anesthesiologist, neurologist, and psychologist. According to MAC, patients were sedated and allowed to breathe spontaneously during the whole procedure. We used target- controlled infusion pumps for fine titration of remifentanil (Ce 0, 5–3 ng/mL) and propofol (Ce 0.5–2 μg/mL). For local infiltration at the site of pin insertion, skin incision, and nerve blocks, a mixture of 0.5% bupivacaine and 2% lidocaine with adrenalin was used. Patients were respiratory and hemodynamic stabile during the whole operation and fully cooperative during motor and language testing. Discussion Anesthetic techniques for awake craniotomy have evolved along with surgical indication, but it varies interinstitutionally and also interindividually. Surgeon's credit is an ability to increase the extent of resection and overall survival, while preserving neurological function. Anesthesiologist's credit is competence to avoid a certain component of general endotracheal anesthesia. With avoidance of general anesthesia, we prevent associated physiological disturbance, need for mechanical ventilation (associated volutrauma and barotrauma), and utilization of anesthetic agents that can play a role on antitumor immunity and tumor progression. It is rational to think that avoiding aforementioned factors may contribute to better outcome after awake brain tumor resection. This important topic still has controversial issues. Learning Points Creation of a competent neuroanesthesiologist, who is able to provide care for awake patients, focuses on pain, sedation, hemodynamic stability, airway management, and constant perioperative support and communication with patient is one of crucial steps in the establishment of an awake surgery.

awake craniotomy, monitored anesthesia care, tumor resection, eloquent brain areas

nije evidentirano