Sokhal Navdeep, Rath Girija Prasad, Chaturvedi Arvind, Dash Hari Hara, Bithal Parmod Kumar, Chandra P Sarat
Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India.
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
Indian J Anaesth. 2015 May;59(5):300-5. doi: 10.4103/0019-5049.156878.
The anaesthetic challenge of awake craniotomy is to maintain adequate sedation, analgesia, respiratory and haemodynamic stability in an awake patient who should be able to co-operate during intraoperative neurological assessment. The current literature, sharing the experience on awake craniotomy, in Indian context, is minimal. Hence, we carried out a retrospective study with the aim to review and analyse the anaesthetic management and perioperative complications in patients undergoing awake craniotomy, at our centre.
Medical records of 54 patients who underwent awake craniotomy for intracranial lesions over a period of 10 years were reviewed, retrospectively. Data regarding anaesthetic management, intraoperative complications and post-operative course were recorded.
Propofol (81.5%) and dexmedetomidine (18.5%) were the main agents used for providing conscious sedation to facilitate awake craniotomy. Hypertension (16.7%) was the most commonly encountered complication during intraoperative period, followed by seizures (9.3%), desaturation (7.4%), tight brain (7.4%), and shivering (5.6%). The procedure had to be converted to general anaesthesia in one of patients owing to refractory brain bulge. The incidence of respiratory and haemodynamic complications were comparable in the both groups (P > 0.05). There was less incidence of intraoperative seizures in patients who received propofol (P = 0.03). In post-operative period, 20% of patients developed new motor deficit. Mean intensive care unit stay was 2.8 ± 1.9 day (1-14 days) and mean hospital stay was 7.0 ± 5.0 day (3-30 days).
'Conscious sedation' was the technique of choice for awake craniotomy, at our institute. Fentanyl, propofol, and dexmedetomidine were the main agents used for this purpose. Patients receiving propofol had less incidence of intraoperative seizure. Appropriate selection of patients, understanding the procedure of surgery, and judicious use of sedatives or anaesthetic agents are key to the success for awake craniotomy as a procedure.
清醒开颅手术的麻醉挑战在于，要在清醒患者中维持足够的镇静、镇痛、呼吸及血流动力学稳定，且该患者应能在术中神经评估期间进行配合。在印度背景下，分享清醒开颅手术经验的现有文献极少。因此，我们开展了一项回顾性研究，旨在回顾和分析我院接受清醒开颅手术患者的麻醉管理及围手术期并发症。
回顾性分析了54例在10年期间因颅内病变接受清醒开颅手术患者的病历。记录了有关麻醉管理、术中并发症及术后病程的数据。
丙泊酚（81.5%）和右美托咪定（18.5%）是用于提供清醒镇静以利于清醒开颅手术的主要药物。高血压（16.7%）是术中最常见的并发症，其次是癫痫发作（9.3%）、血氧饱和度降低（7.4%）、脑膨出（7.4%）和寒战（5.6%）。由于难治性脑膨出，1例患者的手术不得不转为全身麻醉。两组呼吸和血流动力学并发症的发生率相当（P>0.05）。接受丙泊酚的患者术中癫痫发作的发生率较低（P=0.03）。术后，20%的患者出现了新的运动功能障碍。重症监护病房的平均住院时间为2.8±1.9天（1 - 14天），平均住院时间为7.0±5.0天（3 - 30天）。
在我们研究所，“清醒镇静”是清醒开颅手术的首选技术。芬太尼、丙泊酚和右美托咪定是用于此目的的主要药物。接受丙泊酚的患者术中癫痫发作的发生率较低。正确选择患者、了解手术过程以及明智地使用镇静剂或麻醉药物是清醒开颅手术成功的关键。
