Bolzani Nelson Davi, Junqueira Daisy de Oliveira Pollon, Ferrari Paulo André Pinheiro Fernandes, Ferrari Antonio Fernandes, Gaia Felipe, Tapajós Caroline Moraes, Junior José Francisco Cursino de Moura, Neto Edmundo Pereira de Souza
Anesthesiology Team of Presidente Prudente, Hospital Regional de Presidente Prudente, São Paulo, SP, Brazil.
Department of Neurosurgery, Hospital Regional de Presidente Prudente, São Paulo, SP, Brazil; Universidade do Oeste Paulista, Presidente Prudente, São Paulo, SP, Brazil.
Braz J Anesthesiol. 2013 Nov-Dec;63(6):500-3. doi: 10.1016/j.bjane.2013.02.003. Epub 2013 Dec 5.
Some intracranial procedures are achievable with patients awake, however, there are challenges ranging from patient compliance to homeostasis. The aim of this study is to present a case of intracranial surgery for removal of a tumor in the left parietal lobe with the patient awake during the procedure.
After patient selection and psychological preparation, the proposed excision of the left parietal lobe lesion in the waking state was clarified and accepted. Continuous infusion of propofol and remifentanil was administered to maintain a Ramsay score of 2-3. The bilateral scalp blockade was performed with ropivacaine. The Mayfield head fixation device was installed and drapes adjusted to maintain the airway and eyes accessible for mapping with electrical stimulation and tumor excision. For dura mater incision, a pad with 2% lidocaine was applied for 3 minutes. The surgery was uneventful. The patient was discharged on the seventh day of hospitalization without presenting complication.
Although the maintenance of analgesia and hemodynamic stability was a challenge with the patient awake, the target-controlled infusion of propofol provided the desired level of consciousness, remifentanil titrated analgesia and sedation without drug accumulation, and the blockade with ropivacaine provided satisfactory analgesia. We conclude that the anesthetic technique was satisfactory for our patient.
一些颅内手术可在患者清醒状态下进行，然而，从患者依从性到内环境稳定等方面都存在挑战。本研究的目的是介绍一例在患者清醒状态下进行的左顶叶肿瘤切除颅内手术病例。
经过患者筛选和心理准备后，明确并获得了患者对清醒状态下切除左顶叶病变的提议。持续输注丙泊酚和瑞芬太尼以维持 Ramsay 评分在 2 - 3 分。用罗哌卡因进行双侧头皮阻滞。安装 Mayfield 头固定装置并调整手术巾，以保持气道通畅且眼睛可触及，便于进行电刺激定位和肿瘤切除。对于硬脑膜切开，应用含 2%利多卡因的垫子 3 分钟。手术过程顺利。患者在住院第七天出院，未出现并发症。
尽管在患者清醒状态下维持镇痛和血流动力学稳定具有挑战性，但丙泊酚的靶控输注提供了所需的意识水平，瑞芬太尼滴定镇痛和镇静且无药物蓄积，罗哌卡因阻滞提供了满意的镇痛效果。我们得出结论，该麻醉技术对我们的患者而言是令人满意的。
