title: Development of a safe and pragmatic awake craniotomy program at Maine Medical Center.
abstract: BACKGROUND
  Awake craniotomy offers an excellent means of performing intraoperative mapping and optimizing surgical resection of brain tumors. Awake craniotomy relies on a strong collaboration between anesthesiologists, neurosurgeons, and operating room staff. The authors recently introduced awake craniotomy for tumor resection at the Maine Medical Center and propose that it can be performed safely, effectively, and efficiently in a high-volume community hospital.
  
  
  METHODS
  We describe a practical approach to performing awake craniotomy involving streamlined anesthetic protocols and simplified intraoperative testing parameters in a carefully selected group of patients. Our first 25 patients are retrospectively reviewed with particular attention to the anesthetic protocol, the extent of resection, the operative time, post-operative complications, the length of hospitalization, and their functional status at follow-up.
  
  
  RESULTS
  The authors established an anesthetic protocol based primarily on midazolam, fentanyl, propofol, and local anesthetic. The authors note that all but one patient was able to tolerate the awake procedure. Gross total resection was achieved in nearly 80% of patients with a glial tumor. Operative time was short, averaging 159 minutes of entire anesthesia care. Length of stay averaged 3.7 days. Persistent new post-operative deficits were noted in 2 of 25 patients. There was no substantial difference in total hospital charges for patients undergoing awake craniotomy when compared to a matched historical control.
  
  
  CONCLUSIONS
  With attention focused on patient selection and a streamlined anesthetic protocol, the authors were able to successfully implement an awake craniotomy protocol in a community setting with satisfying results, including low operative morbidity, short operative times, low anesthetic complications, and excellent patient tolerance.
authors: Division of Neurosurgery, University of Vermont, Burlington, Vermont, USA.
authors: Anand I
authors: AI
authors: Rughani
authors: Theodor
authors: T
authors: Rintel
authors: Rajiv
authors: R
authors: Desai
authors: Deborah A
authors: DA
authors: Cushing
authors: Jeffrey E
authors: JE
authors: Florman
mesh_terms: D000328:Adult; D000368:Aged; D058109:Airway Management; D000771:Anesthesia, Intravenous; D000777:Anesthetics; D001931:Brain Mapping; D001932:Brain Neoplasms / Q000601:surgery; D003399:Craniotomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D007431:Intraoperative Complications / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D018579:Patient Selection; D011300:Preoperative Care; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome; D014851:Wakefulness
chemical_list: D000777:Anesthetics; D006993:Hypnotics and Sedatives