Mahajan Charu, Rath Girija Prasad, Singh Gyaninder Pal, Mishra Nitasha, Sokhal Suman, Bithal Parmod Kumar
Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
Saudi J Anaesth. 2018 Apr-Jun;12(2):235-239. doi: 10.4103/sja.SJA_608_17.
The goal of awake craniotomy is to maintain adequate sedation, analgesia, respiratory, and hemodynamic stability and also to provide a cooperative patient for neurologic testing. An observational study carried out to evaluate the efficacy of dexmedetomidine sedation for awake craniotomy.
Adult patients with age >18 year who underwent awake craniotomy for intracranial tumor surgery were enrolled. Those who were uncooperative and had difficult airway were excluded from the study. In the operating room, the patients received a bolus dose of dexmedetomidine 1 μg/kg followed by an infusion of 0.2-0.7 μg/kg/h (bispectral index target 60-80). Once the patients were sedated, scalp block was given with bupivacaine 0.25%. The data on hemodynamics at various stages of the procedure, intraoperative complications, total amount of fentanyl used, intravenous fluids required, blood loss and transfusion, duration of surgery, Intensive Care Unit (ICU), and hospital stay were collected. The patients were assessed for Glasgow outcome scale (GOS) score and patient satisfaction score (PSS).
A total of 27 patients underwent awake craniotomy during a period of 2 years. Most common intraoperative complication was seizures; observed in five patients (18.5%). None of these patients experienced any episode of desaturation. Two patients had tight brain for which propofol boluses were administered. The average fentanyl consumption was 161.5 ± 85.0 μg. The duration of surgery, ICU, and hospital stays were 231.5 ± 90.5 min, 14.5 ± 3.5 h, and 4.7 ± 1.5 days, respectively. The overall PSS was 8 and GOS was good in all the patients.
The use of dexmedetomidine infusion with regional scalp block in patients undergoing awake craniotomy is safe and efficacious. The absence of major complications and higher PSS makes it close to an ideal agent for craniotomy in awake state.
清醒开颅手术的目标是维持充分的镇静、镇痛、呼吸及血流动力学稳定，同时使患者能够配合进行神经学检查。开展了一项观察性研究以评估右美托咪定镇静用于清醒开颅手术的疗效。
纳入年龄>18岁、因颅内肿瘤手术接受清醒开颅手术的成年患者。不配合及气道困难的患者被排除在研究之外。在手术室，患者接受1μg/kg的右美托咪定静脉推注，随后以0.2 - 0.7μg/kg/h的速度输注（脑电双频指数目标值为60 - 80）。患者镇静后，用0.25%的布比卡因进行头皮阻滞。收集手术各阶段的血流动力学数据、术中并发症、芬太尼使用总量、所需静脉输液量、失血量及输血量、手术时长、重症监护病房（ICU）停留时间及住院时间。对患者进行格拉斯哥预后评分（GOS）及患者满意度评分（PSS）评估。
在2年期间共有27例患者接受了清醒开颅手术。最常见的术中并发症是癫痫发作；5例患者（18.5%）出现该情况。这些患者均未发生任何血氧饱和度下降的情况。2例患者出现脑紧绷，为此给予了丙泊酚推注。芬太尼平均消耗量为161.5±85.0μg。手术时长、ICU停留时间及住院时间分别为231.5±90.5分钟、14.5±3.5小时及4.7±1.5天。所有患者的总体PSS为8分，GOS良好。
在接受清醒开颅手术的患者中，右美托咪定输注联合局部头皮阻滞的使用是安全有效的。无重大并发症且PSS较高使其近乎成为清醒状态下开颅手术的理想药物。
