Anesthetic management in awake craniotomy

Resection of brain tumors may cause neurological sequelae, according to the site and size of the brain tissue removed. Awake craniotomy has been proposed as a surgical approach to satisfy criteria of radical surgery while minimizing eloquent brain damage. 

The most critical aspect of awake craniotomy is to maintain adequate patient comfort, analgesia, immobility and cooperation during a long surgical operation, ensuring in the meanwhile the safety, control and maintenance of vital functions. 

Apart from pharmacological, surgical, technical knowledge and skillfulness, the ability to maintain close psycho-emotional contact and support with the patient throughout the operation is a fundamental task that the anesthesiologist has to pursue for the operation to be successfully managed.

This review summarizes the current opinion on anesthetic management of patients undergoing awake craniotomy.

anesthesia, awake crani-otomy, brain mapping, brain tumor, neuro-oncology

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2. Blanshard HJ, Chung F, Manninen PH. Awake craniotomy for removal of intracranial tumour: consideration of early discharge. Anesth Analg 2001;92:89-4.

3. Manninen PH, Balki M, Lukitto K. Patient satisfaction with awake craniotomy for tumour surgery: a comparison of remifentanil and fentanyl in conjunction with propofol. Anesth Analg 2006;102:237-2.

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10. Johnson KB, Egan TD. Remifentanil and propofol combination for awake craniotomy: case report with pharmacokinetic simulations. J Neurosurg Anesthesiol 1998;10:25-9.

11. Hans P, Bonhomme V, Born JD, Maertens de Noordhoudt A, Brichant JF, Dewandre PY. Target-controlled infusion of propofol and remifentanil combined with bispetral index monitoring for awake craniotomy. Anaesthesia 2000;55:255-9.

12. Skucas AP, Artru AA. Anaesthetic complications of awake craniotomies for epilepsy surgery. Anesth Analg 2006;102:882-7.

13. Yamamoto F, Kato R, Sato J. anaesthesia for awake craniotomy with non-invasive pressure ventilation. Br J Anaesth 2003;90:382-5.

14. Saltarini M, Zorzi F, Bonassin P. Awake craniotomy: back to the future. NeuroAnesth Crit Care Siena 2005;139-52.

15. Bekker AY, Kaufman B, Samir H, Doyle W. The use of dexmedetomidine infusion for awake craniotomy. Anesth Analg 2001;92(5):1251-3.

16. Moore TA, Markert JM, Knowlton RC. Dexmedetomidine as rescue drug during awake craniotomy for cortical motor mapping and tumour resection. Anesth Analg 2006;102:1556-8.

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