Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, Korea.
Korean J Anesthesiol. 2010 Dec;59 Suppl(Suppl):S179-82. doi: 10.4097/kjae.2010.59.S.S179. Epub 2010 Dec 31.
Despite of various neurophysiologic monitoring methods under general anesthesia, functional mapping at awake state during brain surgery is helpful for conservation of speech and motor function. But, awake craniotomy in children or adolescents is worrisome considering their emotional friabilities. We present our experience on anesthetic management for awake craniotomy in an adolescent patient. The patient was 16 years old male who would undergo awake craniotomy for removal of brain tumor. Scalp nerve block was done with local anesthetics and we infused propofol and remifentanil with target controlled infusion. The patient endured well and was cooperative before scalp suture, but when surgeon sutured scalp, he complained of pain and was suddenly agitated. We decided change to general anesthesia. Neurosurgeon did full neurologic examinations and there was no neurologic deficit except facial palsy of right side. Facial palsy had improved with time.
尽管在全身麻醉下有各种神经生理监测方法，但在脑外科手术中清醒状态下的功能定位有助于保护言语和运动功能。但是，考虑到儿童或青少年的情绪脆弱性，清醒开颅术令人担忧。我们介绍了在一名青少年患者中进行清醒开颅术的麻醉管理经验。患者为 16 岁男性，因脑肿瘤切除而行清醒开颅术。头皮神经阻滞采用局部麻醉，我们通过靶控输注输注丙泊酚和瑞芬太尼。患者在头皮缝合前耐受良好且合作，但当外科医生缝合头皮时，他抱怨疼痛并突然烦躁不安。我们决定改为全身麻醉。神经外科医生进行了全面的神经系统检查，除了右侧面瘫外，没有神经系统缺陷。面瘫随时间推移而改善。
