‘Anesthesia’ for awake neurosurgery

Bilotta, Federico; Rosa, Giovanni

doi:10.1097/aco.0b013e3283302339

Cited by 77 publications

(40 citation statements)

References 40 publications

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“…Dexmedetomidine excites the presynaptic a 2 -AR of the nucleus ceruleus, inhibits the release of norepinephrine and reduces the excitability of postsynaptic membrane, thereby inhibiting the cortical arousal response which is controlled by the dorsal norepinephrine fibre from the nucleus ceruleus, but the function of the wake-up system still exists. In other words, compared with anaesthetic drugs such as midazolam or propofol, which acts in the brain cortex (by gamma aminobutyric acid, GABA) to produce unnatural sedation, dexmedetomidine acts on the subcortical (not related to GABA) system to produce sedative-hypnotic effects similar to the natural sleep which can be stopped by language stimulation [13]. Due to its special 'conscious sedation' effect, in the application of dexmedetomidine for obstetric anaesthesia or analgesia, it is possible that the newborns can 'be woken up' by 'physiological' stimulus after the delivery, which is represented as the phenomenon that the baby can cry naturally after birth.…”

Section: Discussionmentioning

confidence: 99%

Effect and Placental Transfer of Dexmedetomidine During Caesarean Section Under General Anaesthesia

Han

Jiang

et al. 2015

Basic Clin Pharma Tox

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Many drugs can pass through the placenta and cause adverse effects on the foetus. Thus, during Caesarean section for puerperas who have contraindications for intravertebral anaesthesia, the use of proper drugs that have sedative, analgesic effects on the puerperas without adverse effects on the foetus is important. In this study, we investigated the effect and placental transfer of dexmedetomidine during Caesarean section under general anaesthesia. Thirty-eight puerperas were randomly divided to receive dexmedetomidine or saline before anaesthesia induction and during the operation. The dexmedetomidine-treated parturients had lower mean arterial pressure and heart rate at the delivery and at the end of the operation. The dexmedetomidine-treated parturients also needed 5.5% less propofol and 8.4% less fentanyl than the saline-treated ones. Between the dexmedetomidinetreated and saline-treated parturients, there was no difference in the maternal artery, umbilical vein, umbilical artery blood gas analysis results and the Apgar scores at 1 and 5 min. after delivery. The placental transfer rate of dexmedetomidine was 0.76. We concluded that dexmedetomidine was effective in maintaining the haemodynamic stability in the parturients during Caesarean section under general anaesthesia without adverse neonatal effects. Dexmedetomidine can pass through the placenta with a placental transfer rate of 0.76.General anaesthetics usually have obvious effects on newborns, mainly because the sedative, analgesic drugs can pass through the placenta and produce sedation and respiratory inhibition of the foetus, which presents as decreased neonatal activity and Apgar score after delivery. In the puerperas with contraindications for intravertebral anaesthesia, such as coagulopathy, infection at the puncture site, severe back pain history, prolapse of lumber intervertebral disc and sciatica, it is important to choose proper anaesthetics to minimize the effect on the newborns. In recent years, the effect of general anaesthesia on newborns has decreased because of the use of ultra-shortacting anaesthetics, such as propofol and remifentanil. However, finding a drug that will meet the need of general anaesthesia for Caesarean section and has little effect on the neonates is highly warranted in the field of obstetric anaesthesia [1][2][3].Dexmedetomidine is a highly selective a 2 receptor (a 2 -AR) agonist, which has sedative, analgesic, antisympathetic effects and 'conscious sedation without respiratory depression' characteristics.To reduce the effect on the foetus and newborn, the anaesthetic doses are usually controlled under general anaesthesia for the Caesarean section, which causes strong stress reaction. Dexmedetomidine can effectively reduce the stress reaction during tracheal intubation and operation. It has been reported that dexmedetomidine could reduce 17% of the heart rate and 8% of the oxygen consumption during the stress response to tracheal intubation [4].Experiments in animals have shown that dexmedetomidine had no ...

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Section: Discussionmentioning

confidence: 99%

Effect and Placental Transfer of Dexmedetomidine During Caesarean Section Under General Anaesthesia

Han

Jiang

et al. 2015

Basic Clin Pharma Tox

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“…B. Larynxmaske oder Intubation) und ihre intermittierende Unterbrechung für die Testphasen. Etabliert ist außerdem die Kombination von örtlicher Betäubung mit einer Analgosedierung in Spontanatmung (Infiltration oder kraniale Leitungsblockade, [2,8,27,35]). Von einigen Kliniken wird auch die "conscious sedation" bevorzugt, bei der der Patient nur so weit sediert wird, dass er jederzeit kontaktfä-hig bleibt.…”

Section: Schlaf-wach-schlaf-technikunclassified

“…Daneben können auch die anderen bekannten Nebenwirkungen der Anästhe-tika wie Blutdruckschwankungen, Übel-keit und Erbrechen, Schmerzen und Desorientiertheit auftreten. Auch schwerwiegende Zwischenfälle wie Herzinfarkt, Aspiration, Hirndruckerhöhung durch Hypoventilation, unruhiges Erwachen mit Dislokation des Kopfes aus dem Navigationsring oder der Mayfield-Klemme sowie Abbruch der Operation wegen Agitation und fehlender Kooperation wurden beschrieben [2,18].…”

Section: Anästhesieunclassified

Anästhesiologisches Management zur Wachkraniotomie

et al. 2014

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Awake craniotomy is indicated in deep brain stimulation (DBS) for treatment of certain movement disorders, such as in Parkinson disease patients or in the surgery of brain tumors in close vicinity to the language area. The standard procedure is the asleep-awake-asleep technique where general anesthesia or analgosedation is intermittently interrupted for neurological testing. In DBS the intraoperative improvement of symptoms, stereotactic navigation and microelectrode reading guide to the optimal position. In brain tumor resection, reversible functional impairments during electrical stimulation on the brain surface (brain mapping) show the exact individual position of eloquent or motoric areas that should be protected.The anesthesiology procedures used are very variable. It is a balancing act between overdosing of anesthetics with impairment of respiration and alertness and underdosing with pain, strain and stress for the patient. For the asleep-awake-asleep technique high acceptance but also frequent and partly severe complications have been reported. The psychological stress for the patient can be immense. Obviously, a feeling of being left alone and being at someone's mercy is not adequately treated by drugs and performance of the neurological tests is undoubtedly better and more reliable with less pharmacological impairment. Cranial nerve blocks can reduce the amount of anesthetics as they provide analgesia of the scalp more efficiently than local infiltration. With these nerve blocks, a strong therapeutic relationship and a specific communication, sedatives can be avoided and the need for opioids markedly reduced or abolished. The suggestive communication promotes for instance dissociation to an inner safe refuge, as well as reframing of disturbing noises and sensations. Each of the methods applied for awake craniotomy can profit from the principles of this awake-awake-awake technique.

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“…Patients with such indications experience a worse condition of unconsciousness and display lateralizing signs, thus require immediate surgical intervention. 9,10,11,12,13 This case study has focused on recent findings in the anesthetic management of patients undergoing craniotomy while awake, and proposed a structured approach to the clinical practice of 'local anesthesia' for awake neurosurgery. The case holds a significant character as craniotomy for extradural hematoma is a common procedure under general anesthesia but for extradural hematoma craniotomy is not yet reported under local anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Surgical Evacuation Extradural Hematoma under Local Anesthesia

Qureshi¹,

Raja²,

Naim³

et al. 2017

Int. j. endorsing health sci. res.

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Extradural hematoma as a result of traumatic injury is a serious neurological emergency that required immediate intervention. The standard protocol is to identify the condition at earliest and provide quick surgical evacuation of the hematoma. The situation tends to be fatally deteriorating and marks a high mortality rate and worse health outcomes. We have presented a case of extradural hematoma in this study where the surgery had a delay due to the unavailability of general anesthesia. However, the falling Glasgow Coma Scale scores encouraged the surgeons to induce the surgical procedure with the employment of local anesthesia. The intervention turned out to be successful and produced the possibility of using local anesthesia as an alternative in case of critical emergency situations in order to save a life.

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‘Anesthesia’ for awake neurosurgery

Cited by 77 publications

References 40 publications

Effect and Placental Transfer of Dexmedetomidine During Caesarean Section Under General Anaesthesia

Effect and Placental Transfer of Dexmedetomidine During Caesarean Section Under General Anaesthesia

Anästhesiologisches Management zur Wachkraniotomie

Surgical Evacuation Extradural Hematoma under Local Anesthesia

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