title: The impact of sedation on brain mapping: a prospective, interdisciplinary, clinical trial.
abstract: BACKGROUND
  During awake craniotomies, patients may either be awake for the entire duration of the surgical intervention (awake-awake-awake craniotomy, AAA) or initially sedated (asleep-awake-asleep craniotomy, SAS).
  
  
  OBJECTIVE
  To examine whether prior sedation in SAS may restrict brain mapping, we conducted neuropsychological tests in patients by means of a standardized anesthetic regimen comparable to an SAS.
  
  
  METHODS
  We prospectively examined patients undergoing surgery either under total intravenous anesthesia (TIVA) or under regional anesthesia with slight sedation (RAS). The tests included the DO40 picture-naming test, the digit span, the Regensburg Word Fluency Test, and the finger-tapping test. Each test was conducted 3 times for every patient in the TIVA and RAS groups, once before surgery and twice within about 35 minutes after the end of sedation. Patients undergoing AAA were examined preoperatively and intraoperatively.
  
  
  RESULTS
  In the AAA group, no significant difference was found between preoperative and intraoperative test results. In the TIVA and RAS groups, postoperative tests showed worse results than preoperative tests. In most tests, patients improved from the first to the second postoperative test.
  
  
  CONCLUSIONS
  Cognitive and motor performance were significantly influenced by prior sedation in the TIVA and RAS groups, but not in the AAA group. Therefore, prior sedation may be assumed to cause a change in the baselines, which may compromise brain mapping and thus endanger a patient's neurological outcome in the case of an SAS.
authors.affiliation: *Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany; ‡Department of Anaesthesiology, University Medical Centre Regensburg, Regensburg, Germany; §Department of Neurology, University Medical Centre Regensburg, Regensburg, Germany; ¶Department of Neurosurgery, University Medical Centre Regensburg, Regensburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Ott
authors.forename: Christoph
authors.initials: C
authors.lastname: Kerscher
authors.forename: Ralf
authors.initials: R
authors.lastname: Luerding
authors.forename: Christian
authors.initials: C
authors.lastname: Doenitz
authors.forename: Julius
authors.initials: J
authors.lastname: Hoehne
authors.forename: Nina
authors.initials: N
authors.lastname: Zech
authors.forename: Milena
authors.initials: M
authors.lastname: Seemann
authors.forename: Juergen
authors.initials: J
authors.lastname: Schlaier
authors.forename: Alexander
authors.initials: A
authors.lastname: Brawanski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000758:Anesthesia; D001931:Brain Mapping; D001932:Brain Neoplasms / Q000601:surgery*; D016292:Procedural Sedation; D003399:Craniotomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D014851:Wakefulness; D055815:Young Adult