Anaesthesia for awake craniotomy is safe and well-tolerated.
BACKGROUND
Awake craniotomy for tumour resection has been performed at Glostrup Hospital since 2004. We describe and discuss the various anaesthetic approaches for such surgery and retrospectively analyse the 44 planned awake craniotomies performed at Glostrup Hospital. The surgery falls into four phases: craniotomy, mapping, tumour resection and closing. Three methods are being used: monitored anaesthetic care, asleep-awake-asleep and asleep-awake (AA).


METHODS
Anaesthesia is induced and maintained with propofol and remifentanil. A laryngeal mask (LM) is used as an airway during the craniotomy phase. In the AA method, patients are mapped and the tumour is resected while the patient is awake.


RESULTS
A total of 41 of 44 planned AA craniotomies were performed. Three had to be converted into general anaesthesia (GA) due to tight brain, leaking LM and tumour haemorrhage, respectively. The following complications were observed: bradycardia 10%, leaking LM 5%, nausea 10%, vomiting 5%, focal seizures 28%, generalized seizures 10%, hypoxia 2%, hypotension 5% and hypertension 2%.


CONCLUSIONS
Our results comply well with the international literature in terms of complications related to haemodynamics, respiration, seizures, vomiting and nausea and in terms of patient satisfaction. Awake craniotomy is a well-tolerated procedure with potential benefits. More prospective randomized studies are required.
Surgery and Anaesthesiology Department Y, Glostrup Hospital, 2600 Glostrup, Denmark. hessel@dadlnet.dk
Jakob Hessel
JH
Andersen
Karsten Skovgaard
KS
Olsen
D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000009:adverse effects / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000601:surgery*; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods*; D003399:Craniotomy / Q000379:methods*; D004562:Electrocardiography; D005240:Feasibility Studies; D006801:Humans; D015994:Incidence; D010101:Oxygen Consumption; D015742:Propofol / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors
D018686:Anesthetics, Intravenous; D015742:Propofol