Intermittent General Anesthesia With Controlled Ventilation for Asleep-Awake-Asleep Brain Surgery
- 1 October 2012
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurosurgery
- Vol. 71 (4), 764-772
- https://doi.org/10.1227/neu.0b013e3182647ab8
Abstract
Awake brain tumor surgery is a unique opportunity for mapping sensorimotor and cognitive functions, allowing the operator to optimize the resection while preserving the patient's quality of life. During this type of procedure, active participation of the patient is necessary. To assess the efficacy and safety of a method of intermittent general anesthesia with controlled ventilation for performing invasive cerebral mapping. We report our prospective and observational single-center study with an asleep-awake-asleep protocol. Aspects of feasibility, airway management, timing of each phase, and occurrence of adverse events were detailed. During a 35-month period, 140 patients underwent resection of a glioma in an eloquent area. During the asleep phases, controlled ventilation with a laryngeal mask was always efficient. Orotracheal intubation was performed for some patients for the second asleep period. The patients remained fully awake for a mean time of 98 minutes. Postural discomfort was reported in 17.8% of cases. There was 1 case of aspiration of gastric contents with a favorable outcome and no mortality. Intermittent general anesthesia with controlled ventilation for this type of neurosurgical procedure remains an anesthesiological challenge. However, the results of this study suggest that it may be feasible, reproducible, and relatively safe in the context of a standardized protocol involving members of both anesthesiology and surgery teams. Such a technique has a great potential to improve the surgical results, from both oncological and functional perspectives.Keywords
This publication has 22 references indexed in Scilit:
- Mortality related to anaesthesia in France: analysis of deaths related to airway complications*Anaesthesia, 2009
- The asleep–awake technique using propofol–remifentanil anaesthesia for awake craniotomy for cerebral tumoursEuropean Journal of Anaesthesiology, 2008
- Anesthesia management of awake craniotomy performed under asleep-awake-asleep technique using laryngeal mask airway: Report of two casesNeurology India, 2008
- Propofol and Remifentanil Effect-site Concentrations Estimated by Pharmacokinetic Simulation and Bispectral Index Monitoring During Craniotomy With Intraoperative Awakening for Brain Tumor ResectionJournal of Neurosurgical Anesthesiology, 2007
- Anesthesia for awake craniotomy: A retrospective studyNeurology India, 2007
- Anesthetic Complications of Awake Craniotomies for Epilepsy SurgeryAnesthesia & Analgesia, 2006
- Patient Satisfaction with Awake Craniotomy for Tumor Surgery: A Comparison of Remifentanil and Fentanyl in Conjunction with PropofolAnesthesia & Analgesia, 2006
- A Retrospective Analysis of a Remifentanil/Propofol General Anesthetic for Craniotomy Before Awake Functional Brain MappingAnesthesia & Analgesia, 2005
- Remifentanil and Propofol Combination for Awake CraniotomyJournal of Neurosurgical Anesthesiology, 1998
- Propofol Sedation During Awake Craniotomy for SeizuresAnesthesia & Analgesia, 1997