Małłek-Grabowska Małgorzata, Kozlowski Bartosz, Włodarski Robert, Grabowski Piotr B, Hoppe Szymon, Furtak Jacek
Department of Anesthesiology and Intensive Therapy, 10th Military Reaserch Hospital and Polyclinic, Bydgoszcz, Poland.
Faculty of Medicine, University of Science and Technology, Bydgoszcz, Poland.
Am J Case Rep. 2025 May 5;26:e946483. doi: 10.12659/AJCR.946483.
BACKGROUND Awake craniotomy is a neurosurgical procedure that is used when it is necessary for a patient to be conscious during resection of a tumor. In neurosurgical operations conducted within the eloquent cortex, it is essential to administer anesthesia to ensure that the patient does not experience pain or fear during the procedure and to ensure their full cooperation with the neurophysiologist and neurosurgeon in stimulating this cortex. The asleep-awake-asleep method was used in this case of awake craniotomy. In this case report, we evaluate remimazolam, a drug with ultra-short-acting properties and suitability for use in anesthesia during awake craniotomies, for its exceptional utility in this type of treatment. CASE REPORT The case report describes the anesthetic management of a 32-year-old man with morbid obesity (body mass index, 44 kg/m²) who underwent resection of a recurrent tumor (low-grade glioma) in the temporoparietal region. The patient was anesthetized with remimazolam, fentanyl, and remifentanil and underwent a scalp block. The patient did not experience any pain during the surgical procedure and was able to actively cooperate with the neuropsychologist during the crucial phase of tumor resection, once the effects of the anesthetic wore off. The patient's circulatory parameters remained within normal ranges, and no signs of respiratory depression were observed during 225 min of anesthesia. CONCLUSIONS Remimazolam offers an intriguing alternative to conventional sedatives used for sedation during awake craniotomies, particularly for patient groups at high risk of airway obstruction when heavily sedated, such as individuals with severe obesity.
清醒开颅手术是一种神经外科手术，用于在切除肿瘤时患者需要保持清醒的情况。在涉及明确皮层的神经外科手术中，给药麻醉至关重要，以确保患者在手术过程中不会感到疼痛或恐惧，并确保他们在刺激该皮层时与神经生理学家和神经外科医生充分合作。本例清醒开颅手术采用了睡-醒-睡方法。在本病例报告中，我们评估了瑞马唑仑，一种具有超短效特性且适用于清醒开颅手术麻醉的药物，其在这类治疗中的特殊效用。病例报告：该病例报告描述了一名32岁病态肥胖男性（体重指数，44kg/m²）的麻醉管理情况，该患者接受了颞顶叶区域复发性肿瘤（低级别胶质瘤）切除术。患者使用瑞马唑仑、芬太尼和瑞芬太尼进行麻醉，并接受了头皮阻滞。在手术过程中，患者未感到任何疼痛，并且在麻醉效果消退后的肿瘤切除关键阶段能够积极配合神经心理学家。患者的循环参数保持在正常范围内，在225分钟的麻醉过程中未观察到呼吸抑制迹象。结论：瑞马唑仑为清醒开颅手术中用于镇静的传统镇静剂提供了一种有趣的替代选择，特别是对于在深度镇静时气道阻塞风险高的患者群体，如严重肥胖个体。
