Document Detail


Anaesthesia for awake craniotomy--evolution of a technique that facilitates awake neurological testing.
MedLine Citation:
PMID:  12538371     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: There is an increasing trend towards performing craniotomy awake. The challenge for the anaesthetist is to provide adequate analgesia and sedation, haemodynamic stability, and a safe airway, with an awake, cooperative patient for neurological testing. METHODS: The records of all patients who had awake craniotomy at our institution were reviewed. Patients were divided into three groups according to anaesthetic technique. Patients in Group 1 were sedated throughout the procedure. Patients in Groups 2 and 3 had an asleep-awake-asleep technique. Those in Group 2 were anaesthetized with a propofol infusion and fentanyl, and breathed spontaneously through a laryngeal mask airway (LMA). Patients in Group 3 had total i.v. anaesthesia with propofol and remifentanil, and ventilation was controlled using an LMA. We noted the incidence of complications in each group. RESULTS: There were 99 procedures carried out between 1989 and 2002. Group 3 had the fewest complications. No patients in Group 3 developed hypercapnia (E'(CO(2)) >6 kPa), compared with all of the patients in Group 2. Patients in Group 1 had no E'(CO(2)) monitoring, but 7% developed airway obstruction. No patients in Group 3 required additional analgesia for pain, compared with 70% of patients in Group 2. CONCLUSIONS: We have developed a technique for craniotomy, which facilitates awake neurological testing, is safe, and has good patient satisfaction.
Authors:
A Sarang; J Dinsmore
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  British journal of anaesthesia     Volume:  90     ISSN:  0007-0912     ISO Abbreviation:  Br J Anaesth     Publication Date:  2003 Feb 
Date Detail:
Created Date:  2003-01-22     Completed Date:  2003-02-27     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0372541     Medline TA:  Br J Anaesth     Country:  England    
Other Details:
Languages:  eng     Pagination:  161-5     Citation Subset:  IM    
Affiliation:
Department of Anaesthesia, Atkinson Morley's Hospital, Copse Hill, Wimbledon, London SW20 0NE, UK.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Analgesics, Opioid
Anesthesia / methods*
Anesthetics, Combined
Conscious Sedation / methods*
Craniotomy / methods*
Female
Fentanyl
Hemodynamics / drug effects
Humans
Hypercapnia / etiology
Hypnotics and Sedatives
Intraoperative Complications / etiology
Laryngeal Masks
Male
Middle Aged
Piperidines
Propofol
Chemical
Reg. No./Substance:
0/Analgesics, Opioid; 0/Anesthetics, Combined; 0/Hypnotics and Sedatives; 0/Piperidines; 132875-61-7/remifentanil; 2078-54-8/Propofol; 437-38-7/Fentanyl

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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