Surgical strategies for glioma involving language areas

Anaesthesia Management for Awake Craniotomy: Systematic Review and Meta-Analysis

“…The detailed screening, eligibility assessment and inclusion process is shown in Fig 1 . We included a total of forty-seven studies [ 10 , 17 – 62 ] in our SR. One author was personally contacted, and provided us more information about their used anaesthesia technique [ 10 ].…”

“…Data of the study characteristics are shown in Table 1 . A total of fourteen case series [ 10 , 17 , 19 , 20 , 23 , 28 , 39 , 41 , 44 , 47 , 51 , 53 , 54 , 60 ] thirteen prospective studies [ 18 , 21 , 22 , 25 – 27 , 30 , 33 , 35 , 38 , 52 , 55 , 61 ], seventeen retrospective studies [ 24 , 29 , 31 , 34 , 37 , 40 , 42 , 43 , 45 , 46 , 48 – 50 , 57 – 59 , 62 ], two RCTs [ 32 , 56 ], and one pseudo-RCT [ 36 ] comprising 5945 AC procedures in 5931 patients were analysed ( Table 1 ). Of note, during the data extraction process it appeared that nine studies [ 20 , 22 , 27 , 31 , 42 – 46 ] partially repor...…”

“…We divided the identified records into three subtopics according to the used anaesthetic technique: Nineteen studies reported the asleep-awake-asleep (SAS) respectively sleep-awake (SA) technique [ 20 – 23 , 25 – 27 , 37 – 39 , 44 – 46 , 50 , 51 , 53 , 56 , 57 , 60 ], twenty-eight reported monitored anaesthesia care (MAC) [ 10 , 17 – 19 , 24 , 28 – 32 , 34 – 36 , 40 – 43 , 47 – 49 , 52 , 54 , 55 , 58 – 62 ] and one used the awake-awake-awake (AAA) technique [ 33 ]. Of note, Souter et al have used the SAS as well as the MAC technique in their patients [ 60 ].…”

“…Defined by the "American Society of Anesthesiologists" (ASA) this technique enables purposeful patient response to tactile or verbal stimulation, while preserving spontaneous ventilation without any airway instrumentation [ 8 ]. Twenty-eight included studies reported the successful use of MAC in AC [ 10 , 17 – 19 , 24 , 28 – 32 , 34 – 36 , 40 – 43 , 47 – 49 , 52 , 54 , 55 , 58 – 62 ]. Except of three studies, which only used local infiltration anaesthesia [ 36 , 48 , 61 ] respectively one, which did not mention the use of infiltration anaesthesia [ 17 ], all others applied an additional RSNB at the beginning of the surgery.…”

“…Propofol and remifentanil were mostly discontinued 15 minutes before brain mapping and the patients did not receive any sedation and analgesia during the "awake" phase in thirteen studies [ 10 , 17 , 24 , 28 – 31 , 36 , 41 – 43 , 49 , 54 ], respectively three studies which applied only opioids if needed [ 34 , 47 , 52 ]. Three studies continued conscious sedation with propofol in a reduced dosage also during the awake phase [ 18 , 32 ], and the awake anaesthesia management is unknown for six studies [ 19 , 35 , 55 , 58 , 61 , 62 ]. Dexmedetomidine (around 0.1–0.7 μg kg -1 h -1 ) was continued in totally 36 procedures during the "awake" phase [ 48 , 59 , 60 ].…”