Huncke K, Van de Wiele B, Fried I, Rubinstein E H
Department of Anesthesiology, University of California, Los Angeles 90095-1778, USA.
Neurosurgery. 1998 Jun;42(6):1312-6; discussion 1316-7. doi: 10.1097/00006123-199806000-00069.
We evaluated a combined technique designed for procedures requiring intraoperative language mapping. We planned to induce general anesthesia with endotracheal intubation and hyperventilation and then to awaken and extubate the patient for speech testing. After the latter, endotracheal reintubation and general anesthesia were planned.
With the patient under intravenously induced sedation, we topically anesthetized the airway with lidocaine that was delivered through a spraying catheter. Fiberoptic endotracheal intubation was then performed on the awake patient, using a modified endotracheal tube. General anesthesia with intravenous propofol or sodium thiopental was induced, the patient's head was attached to a Mayfield holder, and the pin and operative sites were infiltrated with 0.5% bupivacaine with epinephrine. In anticipation of speech mapping, general anesthesia was discontinued and lidocaine was injected into the catheter that was spirally attached to the endotracheal tube. After speech mapping, the awake patients were endotracheally intubated, guided with the fiberoptic laryngoscope or tube changer, and general anesthesia was induced and maintained until termination of the surgery.
We did not observe any complications, such as coughing or head movements, during the preparation for general anesthesia, awakening and endotracheal extubation for speech mapping, and post-testing reintubation or induction of general anesthesia.
The combined technique that we describe abolished the potential discomfort of surgical stimulation on a sedated patient, reduced the duration of wakefulness, and provided a secure airway and the means to hyperventilate our patients before dural opening.
我们评估了一种为需要术中语言映射的手术设计的联合技术。我们计划通过气管插管和过度通气诱导全身麻醉，然后唤醒并拔除气管导管对患者进行语言测试。在后者之后，计划重新进行气管插管和全身麻醉。
在患者静脉诱导镇静下，我们通过喷雾导管用利多卡因对气道进行表面麻醉。然后使用改良的气管导管对清醒患者进行纤维支气管镜引导下气管插管。诱导静脉注射丙泊酚或硫喷妥钠全身麻醉，将患者头部固定在梅菲尔德头架上，用含肾上腺素的0.5%布比卡因浸润针和手术部位。为了进行语言映射，停止全身麻醉，并将利多卡因注入螺旋连接在气管导管上的导管中。语言映射后，对清醒患者进行气管插管，在纤维喉镜或换管器引导下，诱导并维持全身麻醉直至手术结束。
在全身麻醉准备、唤醒和气管拔管进行语言映射以及测试后重新插管或诱导全身麻醉期间，我们未观察到任何并发症，如咳嗽或头部移动。
我们所描述的联合技术消除了手术刺激对镇静患者的潜在不适，缩短了清醒时间，并在硬脑膜切开前为患者提供了安全的气道和过度通气的方法。
