Mack Patricia Fogarty, Perrine Kenneth, Kobylarz Erik, Schwartz Theodore H, Lien Cynthia A
Weill Medical College of Cornell University, New York, New York 10021, USA.
J Neurosurg Anesthesiol. 2004 Jan;16(1):20-5. doi: 10.1097/00008506-200401000-00005.
Patients are selected for awake craniotomy when the planned procedure involves eloquent areas of the brain, necessitating an awake, cooperative patient capable of undergoing neurocognitive testing. Different anesthetic combinations, including neurolept, propofol with or without opioid infusions, and asleep-awake-asleep techniques, have been reported for awake craniotomy. In all these techniques, respiratory depression has been reported as a complication. In this case series dexmedetomidine, the highly selective alpha-2 adrenoreceptor agonist, was selected for its lack of respiratory depression as well as its sedative and analgesic properties. The charts of 10 consecutive patients who underwent awake craniotomy with dexmedetomidine infusion were reviewed. Five of the patients underwent "asleep-awake" technique with a laryngeal mask airway and volatile agent. Five patients received moderate to conscious sedation. All patients received a dexmedetomidine load of 0.5 to 1.0 microg/kg over 20 minutes followed by an infusion at rates of 0.01 to 1.0 microg/kg per hour. Four patients had extensive sensory and motor testing, and six underwent neurocognitive testing, including naming, reading, counting, and verbal fluency. There were no permanent neurologic deficits, except one patient who had an exacerbation of preoperative language difficulties. Dexmedetomidine appears to be a useful sedative for awake craniotomy when sophisticated neurologic testing is required.
当计划进行的手术涉及大脑的功能区时，需要选择清醒开颅手术的患者，这些患者需要清醒且配合，能够接受神经认知测试。据报道，清醒开颅手术有不同的麻醉组合，包括神经安定麻醉、使用或不使用阿片类药物输注的丙泊酚以及清醒-睡眠-清醒技术。在所有这些技术中，呼吸抑制都被报道为一种并发症。在这个病例系列中，选择了高选择性α-2肾上腺素能受体激动剂右美托咪定，因为它没有呼吸抑制作用，并且具有镇静和镇痛特性。回顾了连续10例接受右美托咪定输注清醒开颅手术患者的病历。其中5例患者采用喉罩气道和挥发性麻醉剂的“清醒-睡眠”技术。5例患者接受了中度至清醒镇静。所有患者在20分钟内接受了0.5至1.0微克/千克的右美托咪定负荷剂量，随后以每小时0.01至1.0微克/千克的速率输注。4例患者进行了广泛的感觉和运动测试，6例患者接受了神经认知测试，包括命名、阅读、计数和语言流畅性测试。除了1例术前语言困难加重的患者外，没有永久性神经功能缺损。当需要进行复杂的神经测试时，右美托咪定似乎是清醒开颅手术中一种有用的镇静剂。
