Comparison of Conscious Sedation and Asleep-Awake-Asleep Techniques for Awake Craniotomy

Dilmen, Özlem Korkmaz; Akçıl, Eren Fatma; Oguz, Abdulvahap; Vehid, Hayriye Ertem; Tunalı, Yusuf

doi:10.1016/j.jocn.2016.10.007

Cited by 37 publications

(50 citation statements)

References 20 publications

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“…33 Dilmen et al more recently reported moderate-to-severe intraoperative desaturations in almost 20% of cases using a dexmedetomidine-based technique, but with unquantified amounts of remifentanil or propofol suplementation. 34 Our study adds to the evidence base, suggesting that use of dexmedetomidine without propofol can be safely performed with no adverse respiratory events, no conversion to general anesthesia, and successful intraoperative mapping throughout. Lobo et al have suggested that for surgeries with an expected duration exceeding four hours, the SAS technique is more appropriate as patients can cooperate better if their awake phase is preceded by an asleep phase.…”

Section: Discussionmentioning

confidence: 59%

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

McAuliffe

Nicholson

Rigamonti

et al. 2018

Can J Anesth/J Can Anesth

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Dexmedetomidine-based anesthesia and scalp block facilitated AC surgery without any requirement for urgent airway intervention or unplanned conversion to a full general anesthetic. This approach can enable physiologic testing before and during tumour resection facilitating real-time surgical decision-making based on intraoperative brain mapping with patients awake thereby minimizing the risk of neurologic deficit and increasing the opportunity for optimal surgical resection.

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Section: Discussionmentioning

confidence: 59%

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

McAuliffe

Nicholson

Rigamonti

et al. 2018

Can J Anesth/J Can Anesth

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“…Besides techniques, also used medication differs between centers performing AC, and several different combinations have been reviewed [7][8][9][11][12][13].…”

Section: Medicationmentioning

confidence: 99%

“…dation (CS) [1,[6][7][8][9][10][11][12][13][14][15][16]. Not only applied techniques, but also used medication and airway devices, differ or have underlain changes and improvements over time [14,17,18].…”

mentioning

confidence: 99%

Dexmedetomidine as adjunct in awake craniotomy – improvement or not?

Raimann¹,

Adam²,

Strouhal³

et al. 2020

ait

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Over the last decade, awake craniotomy (AC) has become a commonly performed neurosurgical procedure for resection of brain tumors in eloquent areas [1]. By cortical and subcortical mapping functional areas can be localized in the awake patient, allowing maximal tumor resection up to functional boundaries [2, 3]. AC has been shown to result in fewer late neurological deficits [4, 5], shorter length of hospital stay [6, 7], and longer overall survival [5], the latter correlating directly with the extent of tumor resection [7]. However, the anesthesiological management for AC shows high variations between centers performing this procedure. So far, different anesthesiological approaches have been reported: asleep-awake-asleep (AAA), asleep-awake (AA), monitored anesthesia care (MAC) and conscious se

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“…Published protocols differ in anesthetic strategies applied during the first phase and the last phase of an awake craniotomy, with two types of protocols being the most well-known [21]. The ''asleep-awake-asleep" protocol calls for the placement of the patient under general anesthesia with a supported airway during the first phase, has the patient awaken with removal of the supported airway in order to attend to functional testing during the second phase, and then has the patient reanesthetized with an re-established airway during the final phase [9,11,14,23]. The ''conscious sedation" protocol calls for a deepened sedation with spontaneous respiration during the initial and final phase of the surgery, and has the patient awaken during the second phase to allow for functional testing [4,8,9].…”

Section: Introductionmentioning

confidence: 99%

The Stony Brook awake craniotomy protocol: A technical note

Shen

Calandra

Geralemou

et al. 2019

Journal of Clinical Neuroscience

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Most current awake craniotomy techniques utilize unnecessarily complicated airway management, and cause discomfort to the patients during the awake phase of the surgery. Our manuscript is written to discuss the neurosurgical and anesthetic techniques that we have developed to optimize awake craniotomy techniques at Stony Brook University Medical Center. We used the frameless Brainlab TM skull-mounted array for stereotactic navigation. Rigid fixation of the skull was avoided. General anesthesia with established airway was used during the ''asleep" phase of the surgery. Following the removal of the bone flap and the opening of the dura, the patients were woken up, and the established airway was removed. Cortical mapping was performed to establish a safe entry zone for tumor removal. While the tumors were being removed, we continued motor examination and casual conversation with the patients to ensure safety. Patients were sedated during the remaining phase of the surgery until skin closure. No patient exhibited any neurological deficits or adverse anesthesia outcomes during the postoperative period. The protocol we developed avoids rigid skull fixation and emphasizes flexible intraoperative planning, thereby maximizing patient and physician comfort while allowing for successful tumor resection.

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Comparison of Conscious Sedation and Asleep-Awake-Asleep Techniques for Awake Craniotomy

Cited by 37 publications

References 20 publications

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

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

Dexmedetomidine as adjunct in awake craniotomy – improvement or not?

The Stony Brook awake craniotomy protocol: A technical note

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