Awake craniotomy using dexmedetomidine and scalp blocks: a retrospective cohort study

McAuliffe, Niamh; Nicholson, S.; Rigamonti, Andrea; Hare, Gregory M. T.; Cusimano, Michael D.; Garavaglia, Marco M.; Pshonyak, Iryna; Das, Sunit

doi:10.1007/s12630-018-1178-z

Cited by 39 publications

(28 citation statements)

References 46 publications

(45 reference statements)

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“…This secondary outcome has informed our use of scalp block for awake craniotomy procedures where we find a circumferential scalp block to be an important aspect of the anesthetic management for patients undergoing awake craniotomy. 5,6 Notably, we did not find any significant differences in the long-term secondary outcomes at postoperative day 30 or 60, and see no reason to believe that the effect at 90 days would be any different.…”

Section: To the Editormentioning

confidence: 51%

In reply: Bilateral scalp blocks help reduce postoperative pain and opioid requirement, but the impact cannot be so huge

Rigamonti

Garavaglia

et al. 2020

Can J Anesth/J Can Anesth

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Section: To the Editormentioning

confidence: 51%

In reply: Bilateral scalp blocks help reduce postoperative pain and opioid requirement, but the impact cannot be so huge

Rigamonti

Garavaglia

et al. 2020

Can J Anesth/J Can Anesth

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“…18 In addition to patient factors, a small number of studies have investigated whether the surgical approach itself has any effect, i.e., specifically if scalp blocks and dexmedetomidine are associated with ISs in patients undergoing awake craniotomy, but did not find this to be a significant contributor. 19,20 As evidenced from the variety of variables that have been found across centers, it is difficult to appreciate a reproducible risk factor that would aid in predicting IS. To date, no papers have been published discussing predictors of ADs.…”

Section: Discussionmentioning

confidence: 99%

Analysis of risk factors and clinical sequelae of direct electrical cortical stimulation–induced seizures and afterdischarges in patients undergoing awake mapping

Abecassis¹,

Ayer²,

Templer

et al. 2021

Journal of Neurosurgery

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OBJECTIVEIntraoperative stimulation has emerged as a crucial adjunct in neurosurgical oncology, aiding maximal tumor resection while preserving sensorimotor and language function. Despite increasing use in clinical practice of this stimulation, there are limited data on both intraoperative seizure (IS) frequency and the presence of afterdischarges (ADs) in patients undergoing such procedures. The objective of this study was to determine risk factors for IS or ADs, and to determine the clinical consequences of these intraoperative events.METHODSA retrospective chart review was performed for patients undergoing awake craniotomy (both first time and repeat) at a single institution from 2013 to 2018. Hypothesized risk factors for ADs/ISs in patients were evaluated for their effect on ADs and ISs, including tumor location, tumor grade (I–IV), genetic markers (isocitrate dehydrogenase 1/2, O6-methylguanine-DNA methyltransferase [MGMT] promoter methylation, chromosome 1p/19q codeletion), tumor volume, preoperative seizure status (yes/no), and dosage of preoperative antiepileptic drugs for each patient. Clinical outcomes assessed in patients with IS or ADs were duration of surgery, length of stay, presence of perioperative deficits, and postoperative seizures. Chi-square analysis was performed for binary categorical variables, and a Student t-test was used to assess continuous variables.RESULTSA total of 229 consecutive patients were included in the analysis. Thirty-five patients (15%) experienced ISs. Thirteen (37%) of these 35 patients had experienced seizures that were appreciated clinically and noted on electrocorticography simultaneously, while 8 patients (23%) experienced ISs that were electrographic alone (no obvious clinical change). MGMT promoter methylation was associated with an increased prevalence of ISs (OR 3.3, 95% CI 1.2–7.8, p = 0.02). Forty patients (18%) experienced ADs. Twenty-three percent of patients (9/40) with ISs had ADs prior to their seizure, although ISs and ADs were not statistically associated (p = 0.16). The presence of ADs appeared to be correlated with a shorter length of stay (5.1 ± 2.6 vs 6.1 ± 3.7 days, p = 0.037). Of the clinical features assessed, none were found to be predictive of ADs. Neither IS nor AD, or the presence of either IS or AD (65/229 patients), was a predictor for increased length of stay, presence of perioperative deficits, or postoperative seizures.CONCLUSIONSISs and ADs, while commonly observed during intraoperative stimulation for brain mapping, do not negatively affect patient outcomes.

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“…In a recent study comparing propofol-remifentanil and dexmedetomidine during awake craniotomy in patients undergoing supratentorial tumor resection, dexmedetomidine provided comparable surgical environment in terms of quality of intraoperative brain mapping and efficacy of sedation, with less respiratory adverse events compared with the propofol-remifentanil group [ 24 ]. Similarly, a retrospective cohort study including 55 patients demonstrated that dexmedetomidine and the scalp nerve block were used successfully in awake craniotomy without any urgent airway intervention or unplanned conversion to general anesthesia [ 25 ]. Although high dose of dexmedetomidine may cause bradycardia, significant inter-individual variability of the sedative state, and a prolonged recovery from sedation after the cessation of infusion, such a high dose is not required during awake craniotomy.…”

Section: Anesthetic Approaches For Awake Craniotomy: Sedative Componementioning

confidence: 99%

Anesthetic considerations for awake craniotomy

Kim

Choi

2020

Anesth Pain Med

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Awake craniotomy is a gold standard of care for resection of brain tumors located within or close to the eloquent areas. Both asleep-awake-asleep technique and monitored anesthesia care have been used effectively for awake craniotomy and the choice of optimal anesthetic approach is primarily based on the preferences of the anesthesiologist and surgical team. Propofol, remifentanil, dexmedetomidine, and scalp nerve block provide the reliable conditions for intraoperative brain mapping. Appropriate patient selection, adequate perioperative psychological support, and proper anesthetic management for individual patients in each stage of surgery are crucial for procedural safety, success, and patient satisfaction.

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Awake craniotomy using dexmedetomidine and scalp blocks: a retrospective cohort study

Cited by 39 publications

References 46 publications

In reply: Bilateral scalp blocks help reduce postoperative pain and opioid requirement, but the impact cannot be so huge

In reply: Bilateral scalp blocks help reduce postoperative pain and opioid requirement, but the impact cannot be so huge

Analysis of risk factors and clinical sequelae of direct electrical cortical stimulation–induced seizures and afterdischarges in patients undergoing awake mapping

Anesthetic considerations for awake craniotomy

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