Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
Anaesthesiol Intensive Ther. 2020;52(1):15-22. doi: 10.5114/ait.2020.93043.
Over the last decade, awake craniotomy for tumor resection has become a standard to maximize tumor resection and minimize the risk of permanent neurological deficits. Different techniques and medication regimes have been tested for this procedure. Until today there is no consensus on the optimal approach. Therefore, we investigated the effect of dexmedetomidine as an adjunct in awake cerebral tumor surgery and evaluated our improved technique.
Data of patients who underwent awake craniotomy for tumor resection at our institution between 09/2006 and 05/2018 were retrospectively analyzed. All patients were kept awake after cortical mapping. After changing our standard anesthetic procedure from propofol/remifentanil alone to propofol/remifentanil and dexmedetomidine, we performed an evaluation of time to arousal, drug dosages, patients' cooperation and the occurrence of periprocedural adverse events.
Eighty-four patients received propofol/remifentanil alone (SG). A further 17 patients additionally received dexmedetomidine following craniotomy in order to induce rapid arousal (DG). In the dexmedetomidine group a significantly reduced infusion time for propofol (169.2 ± 47.4 vs. 212.9 ± 63.3 minutes; P = 0.008) and non-significantly shorter time to arousal (12.0 [10.0/16.5] vs. 15.0 [10.0/20.0] minutes; P = 0.271) could be identified. In general, the overall procedure was very well tolerated by all patients.
The asleep-awake technique is a well-accepted and safe procedure. It allows continuous surveillance of the patient's neurological function during tumor resection and the postoperative phase, minimizing complications. In addition, our data show that the use of dexmedetomidine results in a shorter time to arousal.
在过去的十年中，清醒开颅术已成为最大限度切除肿瘤并降低永久性神经功能缺损风险的标准。不同的技术和药物方案已用于该手术。直到今天，对于最佳方案仍没有共识。因此，我们研究了右美托咪定作为清醒脑肿瘤手术辅助药物的效果，并评估了我们改进的技术。
回顾性分析了 2006 年 9 月至 2018 年 5 月在我院接受清醒开颅肿瘤切除术的患者数据。所有患者在皮质映射后保持清醒。在改变我们的标准麻醉方案，从单独使用异丙酚/瑞芬太尼改为异丙酚/瑞芬太尼和右美托咪定后，我们评估了觉醒时间、药物剂量、患者配合度以及围手术期不良事件的发生情况。
84 例患者单独接受异丙酚/瑞芬太尼（SG 组）麻醉，另外 17 例患者在开颅后接受右美托咪定辅助以实现快速觉醒（DG 组）。在右美托咪定组，异丙酚的输注时间显著缩短（169.2 ± 47.4 分钟 vs. 212.9 ± 63.3 分钟；P = 0.008），但觉醒时间差异无统计学意义（12.0 [10.0/16.5] 分钟 vs. 15.0 [10.0/20.0] 分钟；P = 0.271）。总的来说，所有患者均能很好地耐受整个手术过程。
入睡-觉醒技术是一种被广泛接受且安全的手术方法。它允许在肿瘤切除和术后阶段持续监测患者的神经功能，最大程度地减少并发症。此外，我们的数据表明，右美托咪定的使用可缩短觉醒时间。
