D'Onofrio Grazia, Izzi Antonio, Manuali Aldo, Bisceglia Giuliano, Tancredi Angelo, Marchello Vincenzo, Recchia Andreaserena, Tonti Maria Pia, Icolaro Nadia, Fazzari Elena, Carotenuto Vincenzo, De Bonis Costanzo, Savarese Luciano, Gorgoglione Leonardo Pio, Del Gaudio Alfredo
Clinical Psychology Service, Health Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71013 Foggia, Italy.
Complex Unit of Anaesthesia-2, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71013 Foggia, Italy.
Brain Sci. 2023 Jul 5;13(7):1031. doi: 10.3390/brainsci13071031.
Our anesthetic technique proposed for awake craniotomy is the monitored anesthesia care (MAC) technique, with the patient in sedation throughout the intervention. Our protocol involves analgo-sedation through the administration of dexmedetomidine and remifentanil in a continuous intravenous infusion, allowing the patient to be sedated and in comfort, but contactable and spontaneously breathing. Pre-surgery, the patient is pre-medicated with intramuscular clonidine (2 µg/kg); it acts both as an anxiolytic and as an adjuvant in pain management and improves hemodynamic stability. In the operating setting, dexmedetomidine in infusion and remifentanil in target controlled infusion (TCI) for effect are started. The purpose of the association is to exploit the pharmacodynamics of dexmedetomidine which guarantees the control of respiratory drive, and the pharmacokinetics of remifentanil characterized by insensitivity to the drug. Post-operative management: at the end of the surgical procedure, the infusion of drugs was suspended. Wake-up craniotomy is associated with reduced hospital costs compared to craniotomy performed in general anesthesia, mainly due to reduced costs in the operating room and shorter hospital stays. Greater patient satisfaction and the benefits of avoiding hospital stay have led to the evolution of outpatient intracranial neurosurgery.
我们为清醒开颅手术提出的麻醉技术是监测麻醉管理（MAC）技术，在整个干预过程中患者处于镇静状态。我们的方案包括通过持续静脉输注右美托咪定和瑞芬太尼进行镇痛镇静，使患者处于镇静且舒适的状态，但能够被唤醒并自主呼吸。术前，患者肌肉注射可乐定（2μg/kg）进行预处理；它兼具抗焦虑作用和疼痛管理辅助作用，并可改善血流动力学稳定性。在手术过程中，开始输注右美托咪定并采用靶控输注（TCI）瑞芬太尼以达到预期效果。联合使用这两种药物的目的是利用右美托咪定的药效学特性来确保对呼吸驱动的控制，以及瑞芬太尼对药物不敏感的药代动力学特性。术后管理：手术结束时，停止药物输注。与全身麻醉下进行的开颅手术相比，清醒开颅手术可降低医院成本，这主要是由于手术室成本降低和住院时间缩短。患者满意度更高以及避免住院的好处促使了门诊颅内神经外科手术的发展。
