Min Kyeong Tae
Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.
Anesth Pain Med (Seoul). 2025 Jan;20(1):23-33. doi: 10.17085/apm.24183. Epub 2025 Jan 25.
Monitored anesthesia care is a feasible option for anesthetic management during awake craniotomy. Patients selected for surgery are thoroughly evaluated by anesthesiologists, primarily focusing on their risk for airway emergencies, such as respiratory depression and obstruction, throughout the procedure. For patients with relative contraindications, a tailored approach is used to assess their suitability. Neuropsychiatric counseling is also helpful for enhancing the patient's ability to participate in and perform the necessary tasks during brain mapping. Building good rapport with the patient is essential for the success of awake craniotomy, as it helps foster trust and cooperation. Analgesia during awake craniotomy is primarily achieved through scalp nerve blocks or infiltration. Among the six scalp nerve blocks, I have described the zygotemporal nerve block in detail. Proper positioning is crucial for both the surgical approach and the safety and comfort of the patient. Even when local anesthetics are effectively administered, many patients may still experience mild to moderate pain during the procedure. This pain is common and transient, typically occurring around the temporal region. In some cases, sedatives or additional analgesics may be necessary. Serious adverse events can arise, including those that require urgent life-saving interventions or those that interfere with brain mapping and the patient's ability to perform tasks. However, MAC in neurosurgery offers the potential for an improved quality of life for individuals with brain tumors or epileptic seizures, as well as for those with disabilities, such as the deaf or visually impaired, in the future.
监测麻醉管理是清醒开颅手术麻醉管理的一种可行选择。接受手术的患者由麻醉医生进行全面评估，在整个手术过程中主要关注其气道紧急情况的风险，如呼吸抑制和气道梗阻。对于有相对禁忌证的患者，采用量身定制的方法来评估其适用性。神经心理辅导也有助于增强患者在脑图谱绘制过程中参与并完成必要任务的能力。与患者建立良好的关系对于清醒开颅手术的成功至关重要，因为这有助于建立信任与合作。清醒开颅手术期间的镇痛主要通过头皮神经阻滞或浸润来实现。在六种头皮神经阻滞中，我已详细描述了颧颞神经阻滞。正确的体位对于手术入路以及患者的安全和舒适度都至关重要。即使有效给予局部麻醉药，许多患者在手术过程中仍可能会经历轻度至中度疼痛。这种疼痛很常见且是短暂的，通常发生在颞部周围。在某些情况下，可能需要使用镇静剂或额外的镇痛药。可能会出现严重不良事件，包括那些需要紧急救命干预的事件或那些干扰脑图谱绘制及患者执行任务能力的事件。然而，神经外科手术中的监测麻醉管理有可能改善脑肿瘤或癫痫患者以及未来残疾患者（如聋人或视力障碍者）的生活质量。
