Document Detail

Awake craniotomy induces fewer changes in the plasma amino acid profile than craniotomy under general anesthesia.
MedLine Citation:
PMID:  19295387     Owner:  NLM     Status:  MEDLINE    
In this prospective, observational, 2-armed study, we compared the plasma amino acid profiles of patients undergoing awake craniotomy to those undergoing craniotomy under general anesthesia. Both experimental groups were also compared with a healthy, age-matched and sex-matched reference group not undergoing surgery. It is our intention to investigate whether plasma amino acid levels provide information about physical and emotional stress, as well as pain during awake craniotomy versus craniotomy under general anesthesia. Both experimental groups received preoperative, perioperative, and postoperative dexamethasone. The plasma levels of 20 amino acids were determined preoperative, perioperative, and postoperatively in all groups and were correlated with subjective markers for pain, stress, and anxiety. In both craniotomy groups, preoperative levels of tryptophan and valine were significantly decreased whereas glutamate, alanine, and arginine were significantly increased relative to the reference group. Throughout time, tryptophan levels were significantly lower in the general anesthesia group versus the awake craniotomy group. The general anesthesia group had a significantly higher phenylalanine/tyrosine ratio, which may suggest higher oxidative stress, than the awake group throughout time. Between experimental groups, a significant increase in large neutral amino acids was found postoperatively in awake craniotomy patients, pain was also less and recovery was faster. A significant difference in mean hospitalization time was also found, with awake craniotomy patients leaving after 4.53+/-2.12 days and general anesthesia patients after 6.17+/-1.62 days; P=0.012. This study demonstrates that awake craniotomy is likely to be physically and emotionally less stressful than general anesthesia and that amino acid profiling holds promise for monitoring postoperative pain and recovery.
Jaap W Hol; Markus Klimek; Marieke van der Heide-Mulder; Dirk Stronks; Arnoud J Vincent; Jan Klein; Freek J Zijlstra; Durk Fekkes
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of neurosurgical anesthesiology     Volume:  21     ISSN:  1537-1921     ISO Abbreviation:  J Neurosurg Anesthesiol     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-03-19     Completed Date:  2009-05-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8910749     Medline TA:  J Neurosurg Anesthesiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  98-107     Citation Subset:  IM    
Department of Anesthesiology, Erasmus MC, Rotterdam, The Netherlands.
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MeSH Terms
Amino Acids / blood*
Anesthesia, General / adverse effects*
Anesthesia, Local / adverse effects*
Anxiety / psychology
Craniotomy / adverse effects*
Middle Aged
Nitric Oxide / blood
Pain, Postoperative / epidemiology
Preanesthetic Medication
Prospective Studies
Quality of Life
Stress, Psychological / psychology
Treatment Outcome
Reg. No./Substance:
0/Amino Acids; 10102-43-9/Nitric Oxide

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