Hostname: page-component-8448b6f56d-gtxcr Total loading time: 0 Render date: 2024-04-20T05:53:00.693Z Has data issue: false hasContentIssue false
  • English
  • Français

The asleep–awake technique using propofol–remifentanil anaesthesia for awake craniotomy for cerebral tumours

Published online by Cambridge University Press:  01 August 2008

K. S. Olsen
K. S. Olsen*
Affiliation:
Glostrup University Hospital, Department of Anaesthesia and Intensive Care, Glostrup, Denmark
*
Correspondence to: Karsten Skovgaard Olsen, Department of Anaesthesia and Intensive Care, Glostrup Hospital, DK-2600 Glostrup, Denmark. E-mail: karsko01@glostruphosp.kbhamt.dk; Tel: +45 43233160; Fax: +45 43233941
Get access

Summary

Background and objective

We retrospectively reviewed the first 25 planned cases of awake craniotomies using the ‘asleep–awake’ technique, an alternative to the often-used ‘asleep–awake–asleep’ technique.

Methods

The patients were anaesthetized using propofol/remifentanil anaesthesia, a laryngeal mask and controlled ventilation according to a protocol defined before the start of this series of patients. The patients were awakened before the brain mapping and were kept awake throughout the rest of the procedure allowing for additional mapping and modification of the resection of the tumour if symptoms should develop. A small dose of remifentanil was infused during this period if necessary.

Results

Twenty-three patients were mapped as planned. One patient was not awakened due to protrusion of the brain during the awakening phase. Another patient was intubated preoperatively as it was impossible to obtain a tight laryngeal mask. All of the 23 patients were awake as from when the mapping session began and throughout the rest of the operation. In five cases the resection of the tumour was modified as symptoms emerged. These symptoms all subsided in due course. No case of hypoxia was recorded. In no case the respiratory rate was below 10 breaths min−1 in the awake period. Complications were comparable to other studies. The patients in the present study were all satisfied with the method.

Conclusions

Different methods of anaesthesia have been described, but no method has been shown to be superior. The presented method seems to be a rational and useful technique allowing for modification of tumour resection, if symptoms should develop. The method was well tolerated by the patients.

Keywords

ANAESTHESIA GENERALPROPOFOLREMIFENTANILNEUROSURGERYCRANIOTOMY, awake
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 8 , August 2008 , pp. 662 - 669
Copyright
Copyright © European Society of Anaesthesiology 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Sareng, A, Dinsmore, J. Anaesthesia for awake craniotomy – evolution of a technique that facilitates awake neurological testing. Br J Anaesth 2003; 90: 161–165.CrossRefGoogle Scholar
2.Hans, P, Bonhomme, V, Born, J et al. Target-controlled infusion of propofol and remifentanil combined with bispectral index monitoring for awake craniotomy. Anesthesia 2000; 55: 255–259.CrossRefGoogle ScholarPubMed
3.Berkenstadt, HPA, Hadani, M, Unofrievich, I, Ram, Z. Monitored anesthesia care using remifentanil and propofol for awake craniotomy. J Neurosurg Anesthesiol 2001; 13: 246–249.CrossRefGoogle ScholarPubMed
4.Tongier, WK, Joshi, GP, Landers, DF, Mickey, B. Use of laryngeal mask airway during awake craniotomy for tumor resection. J Clin Anesth 2000; 12: 592–594.CrossRefGoogle ScholarPubMed
5.Andrews Danks, R, Aglio, LS, Gugino, LD, Black, PM. Craniotomy under local anesthesia and monitored conscious sedation for the resection of tumors involving eloquent cortex. J Neurooncol 2000; 49: 131–139.CrossRefGoogle Scholar
6.Johnson, K, Egan, T. Remifentanil and propofol combination for awake craniotomy: case report with pharmacokinetic simulations. J Neurosurg Anesthesiol 1998; 10: 25–29.CrossRefGoogle ScholarPubMed
7.Huncke, K, Van de Wiele, B, Fried, I, Rubinstein, EH. The asleep-awake-asleep anesthetic technique for intraoperative language mapping. J Neurosurg 1998; 42: 1312–1316.CrossRefGoogle ScholarPubMed
8.Danks, RA, Rogers, M, Aglio, L, Gugino, L, Black, PM. Patient tolerance of craniotomy performed with the patient under local anesthesia and monitored conscious sedation. Neurosurgery 1998; 42: 28–36.CrossRefGoogle ScholarPubMed
9.Archer, DP, McKenna, JM, Morin, L et al. Conscious-sedation analgesia during craniotomy for intractable epilepsy: a review of 354 consecutive cases. Can J Anaesth 1988; 35: 338–344.CrossRefGoogle ScholarPubMed
10.Mack, PF, Perrine, KP, Schwartz, TH, Lien, CA. Dexmedetomidine and neurocognitive testing in awake craniotomy. J Neurosurg Anesthesiol 2004; 16: 20–25.CrossRefGoogle ScholarPubMed
11.Ard, JL, Bekker, AY, Doyle, WK. Dexmedetomidine in awake craniotomy: a technical note. Surg Neurol 2005; 63: 114–116.CrossRefGoogle ScholarPubMed
12.Keifer, JC, Dentchev, D, Little, K, Warner, DS, Friedman, AH, Borel, CO. A retrospective analysis of a remifentanil/propofol general anesthetic for craniotomy before awake functional brain mapping. Anesth Analg 2005; 101: 502–508.CrossRefGoogle ScholarPubMed
13.Yamamoto, F, Kato, R, Sato, J, Nishino, T. Anaesthesia for awake craniotomy with non-invasive positive pressure ventilation. Br J Anaesth 2003; 90: 382–385.CrossRefGoogle ScholarPubMed
14.Audu, PB, Loomba, N. Use of oropharyngeal airway (COPA) for awake intracranial surgery. J Neurosurg Anesthesiol 2004; 16: 144–146.CrossRefGoogle ScholarPubMed
15.Manninen, PH, Balki, M, Lukitto, K, Bernstein, M. Patient satisfaction with awake craniotomy for tumor surgery: a comparison of remifentanil and fentanyl in conjunction with propofol. Anesth Analg 2006; 102: 237–242.CrossRefGoogle ScholarPubMed
16.Sartorius, CJ, Wright, G. Intraoperative brain mapping in a community setting-technical considerations. Surg Neurol 1997; 47: 380–388.CrossRefGoogle Scholar
17.Blanshard, HJ, Chung, F, Manninen, PH, Taylor, MD, Bernstein, M. Awake craniotomy for removal of intracraniel tumor: considerations for early discharge. Anesth Analg 2001; 92: 89–94.CrossRefGoogle Scholar
18.Whittle, IR, Midgley, S, Georges, H, Pringle, AM, Taylor, R. Patient perception of “awake” brain tumour surgery. Acta Neurochir 2005; 147: 275–277.CrossRefGoogle ScholarPubMed
19.Herrick, IA, Craen, RA, Blume, WT, Novick, T, Gelb, AW. Sedative doses of remifentanil have minimal effect on ECoG spike activity during awake epilepsy surgery. J Neurosurg Anesthesiol 2002; 14: 55–58.CrossRefGoogle ScholarPubMed
20.Bernstein, B. Outpatient craniotomy for brain tumor: a pilot feasibility study of 46 patients. Can J Neurol Sci 2001; 28: 120–124.CrossRefGoogle ScholarPubMed