title: Anesthesia for awake craniotomy: case report.
abstract: OBJECTIVE
  Some intracranial procedures are achievable with patients awake, however, there are challenges ranging from patient compliance to homeostasis. The aim of this study is to present a case of intracranial surgery for removal of a tumor in the left parietal lobe with the patient awake during the procedure.
  
  
  METHODS
  After patient selection and psychological preparation, the proposed excision of the left parietal lobe lesion in the waking state was clarified and accepted. Continuous infusion of propofol and remifentanil was administered to maintain a Ramsay score of 2-3. The bilateral scalp blockade was performed with ropivacaine. The Mayfield head fixation device was installed and drapes adjusted to maintain the airway and eyes accessible for mapping with electrical stimulation and tumor excision. For dura mater incision, a pad with 2% lidocaine was applied for 3 minutes. The surgery was uneventful. The patient was discharged on the seventh day of hospitalization without presenting complication.
  
  
  CONCLUSIONS
  Although the maintenance of analgesia and hemodynamic stability was a challenge with the patient awake, the target-controlled infusion of propofol provided the desired level of consciousness, remifentanil titrated analgesia and sedation without drug accumulation, and the blockade with ropivacaine provided satisfactory analgesia. We conclude that the anesthetic technique was satisfactory for our patient.
authors.affiliation: Anesthesiology Team of Presidente Prudente, Hospital Regional de Presidente Prudente, São Paulo, SP, Brazil.
authors.forename: Nelson Davi
authors.initials: ND
authors.lastname: Bolzani
authors.affiliation: Anesthesiology Team of Presidente Prudente, Hospital Regional de Presidente Prudente, São Paulo, SP, Brazil.
authors.forename: Daisy de Oliveira Pollon
authors.initials: Dde O
authors.lastname: Junqueira
authors.affiliation: Department of Neurosurgery, Hospital Regional de Presidente Prudente, São Paulo, SP, Brazil; Universidade do Oeste Paulista, Presidente Prudente, São Paulo, SP, Brazil.
authors.forename: Paulo André Pinheiro Fernandes
authors.initials: PA
authors.lastname: Ferrari
authors.affiliation: Department of Neurosurgery, Hospital Regional de Presidente Prudente, São Paulo, SP, Brazil; Universidade do Oeste Paulista, Presidente Prudente, São Paulo, SP, Brazil.
authors.forename: Antonio Fernandes
authors.initials: AF
authors.lastname: Ferrari
authors.affiliation: Department of Neurosurgery, Hospital Regional de Presidente Prudente, São Paulo, SP, Brazil; Universidade do Oeste Paulista, Presidente Prudente, São Paulo, SP, Brazil.
authors.forename: Felipe
authors.initials: F
authors.lastname: Gaia
authors.affiliation: Anesthesiology Team of Presidente Prudente, Hospital Regional de Presidente Prudente, São Paulo, SP, Brazil.
authors.forename: Caroline Moraes
authors.initials: CM
authors.lastname: Tapajós
authors.affiliation: Anesthesiology Team of Presidente Prudente, Hospital Regional de Presidente Prudente, São Paulo, SP, Brazil; Universidade do Oeste Paulista, Presidente Prudente, São Paulo, SP, Brazil.
authors.forename: José Francisco Cursino de Moura
authors.initials: JF
authors.lastname: Junior
authors.affiliation: Anesthesiology Team of Presidente Prudente, Hospital Regional de Presidente Prudente, São Paulo, SP, Brazil; Universidade do Oeste Paulista, Presidente Prudente, São Paulo, SP, Brazil; Service of Reanimation and Anesthesiology, Hospices Civils de Lyon, Groupement Hospitalier Est, Hôpital Neurologique Pierre Wertheimer, Bron, France; National Center for Scientific Research, Laboratory of Physics, Ecole Normale Supérieure de Lyon, Lyon, France. Electronic address: edmundo.pereira-de-souza@hotmail.fr.
authors.forename: Edmundo Pereira de Souza
authors.initials: EP
authors.lastname: Neto
mesh_terms: D000328:Adult; D000577:Amides / Q000008:administration & dosage; D000758:Anesthesia / Q000379:methods*; D001932:Brain Neoplasms / Q000503:physiopathology / Q000601:surgery; D003399:Craniotomy / Q000379:methods*; D006801:Humans; D008297:Male; D010880:Piperidines / Q000008:administration & dosage; D015742:Propofol / Q000008:administration & dosage; D000077208:Remifentanil; D000077212:Ropivacaine
chemical_list: D000577:Amides; D010880:Piperidines; D000077212:Ropivacaine; D000077208:Remifentanil; D015742:Propofol
keywords: Craniotomy awake; Neurosurgery; Propofol; Remifentanil; Ropivacaine