1Department of Neurosurgery, and.
2Department of Anaesthesiology, Intensive Care and Pain Therapy, University Hospital of Münster, Germany.
J Neurosurg. 2018 Nov 1;129(5):1223-1230. doi: 10.3171/2017.7.JNS171312. Epub 2018 Jan 12.
OBJECTIVEAwake craniotomies have become a feasible tool over time to treat brain tumors located in eloquent regions. Different techniques have been applied in neurooncology centers. Both "asleep-awake-asleep" (asleep) and "conscious sedation" were used subsequently at the authors' neurosurgical department. Since 2013, the authors have only performed conscious sedation surgeries, predominantly using the α2-receptor agonist dexmedetomidine as the anesthetic drug. The aim of this study was to compare both mentioned techniques and evaluate the clinical use of dexmedetomidine in the setting of awake craniotomies for glioma surgery.METHODSThe authors retrospectively analyzed patients who underwent operations either under the asleep condition using propofol-remifentanil or under conscious sedation conditions using dexmedetomidine infusions. In the asleep group patients were intubated with a laryngeal mask and extubated for the assessment period. Adverse events, as well as applied drugs with doses and frequency of usage, were recorded.RESULTSFrom 224 awake surgeries between 2009 and 2015, 180 were performed for the resection of gliomas and included in the study. In the conscious sedation group (n = 75) significantly fewer opiates (p < 0.001) and vasoactive (p < 0.001) and antihypertensive (p < 0.001) drugs were used in comparison with the asleep group (n = 105). Furthermore, the postoperative length of stay (p < 0.001) and the surgical duration (p < 0.001) were significantly lower in the conscious sedation group.CONCLUSIONSUse of dexmedetomidine creates excellent conditions for awake surgeries. It sedates moderately and acts as an anxiolytic. Thus, after ceasing infusion it enables quick and reliable clinical neurological assessment of patients. This might lead to reducing the amount of administered antihypertensive and vasoactive drugs as well as the length of hospitalization, while likely ensuring more rapid surgery.
清醒开颅术已成为治疗位于功能区脑肿瘤的可行工具。神经肿瘤学中心应用了不同的技术。作者所在神经外科部门随后同时应用了“麻醉-清醒-麻醉”（全麻）和“镇静”技术。自 2013 年以来，作者仅进行清醒镇静手术，主要使用α2-受体激动剂右美托咪定为麻醉药物。本研究旨在比较这两种技术，并评估右美托咪定在清醒开颅术治疗胶质瘤中的临床应用。
作者回顾性分析了 2009 年至 2015 年期间在全身麻醉下（使用丙泊酚-瑞芬太尼）或在清醒镇静下（使用右美托咪定输注）进行手术的患者。在全麻组，患者使用喉罩插管，并在评估期拔管。记录不良事件以及应用药物的剂量和使用频率。
在 2009 年至 2015 年期间进行的 224 例清醒手术中，有 180 例用于切除胶质瘤并纳入本研究。在清醒镇静组（n=75）中，与全麻组（n=105）相比，使用的阿片类药物（p<0.001）、血管活性药物（p<0.001）和抗高血压药物（p<0.001）明显减少。此外，在清醒镇静组中，术后住院时间（p<0.001）和手术时间（p<0.001）明显缩短。
使用右美托咪定可为清醒手术创造极佳条件。它具有适度的镇静作用，并具有抗焦虑作用。因此，停止输注后，可快速、可靠地对患者进行临床神经学评估。这可能会减少使用的抗高血压药物和血管活性药物的量以及住院时间，同时可能确保手术更快进行。
