Anaes SAQs · Neuroanaesthesia
Awake craniotomy anaesthesia
Final-examination SAQ for awake-craniotomy.
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Model answer
Selection & consent (3). Cooperative patient, language matched to mapping, risks of seizure/deficit/conversion.[4]
Technique (4). AAA vs MAC (MAC lower failure 1% vs 4%, SAS fewer seizures); scalp block; pins; propofol-based sedation or dexmedetomidine (load 1.0 microg/kg, 0.2–0.7 microg/kg/h); lighten mapping-blunting sedatives during testing.[4][5][7]
Airway (3). Supraglottic airway or ETT asleep phases (recheck seal after positioning); spontaneous ventilation awake; conversion kit ready.[2][9]
Seizure & conversion (5). Cold saline, stop stimulation, anticonvulsant/propofol, secure airway if needed; convert for airway failure, severe agitation, refractory seizures, or surgical emergency.[8]
References9ShowHide
- [1]Goettel N, Bharadwaj S, Venkatraghavan L, et al. Dexmedetomidine vs propofol-remifentanil conscious sedation for awake craniotomy: RCT. Br J Anaesth, 2016.PMID 27099154
- [2]Frerk C, Mitchell VS, McNarry AF, et al. DAS 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth, 2015.PMID 26556848
- [3]Davidson AJ, Disma N, de Graaff JC, et al. Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial. Lancet, 2016.PMID 26507180
- [4]Kulikov A, Lubnin A. Anesthesia for awake craniotomy. Curr Opin Anaesthesiol, 2018.PMID 29994938
- [5]Natalini D, Ganau M, Rosenkranz R, et al. Comparison of the Asleep-Awake-Asleep Technique and Monitored Anesthesia Care During Awake Craniotomy: A Systematic Review and Meta-analysis. J Neurosurg Anesthesiol, 2022.PMID 31972627
- [6]Seo H, Kim E, Jung H, et al. Optimal dose of mannitol for intraoperative brain relaxation in supratentorial tumour craniotomy. J Neurosurg, 2017.PMID 27540904
- [7]Shen SL, Zheng JY, Zhang J, et al. Dexmedetomidine vs propofol for conscious sedation in awake craniotomy: RCT. Ann Pharmacother, 2013.PMID 24259599
- [8]Mamani R, Jacobo JA, Mejia S, et al. Intraoperative seizures during bipolar brain mapping in eloquent areas. Clin Neurol Neurosurg, 2020.PMID 33096426
- [9]Zhao Y, Li P, Li DW, et al. Severe gastric insufflation and consequent atelectasis caused by gas leakage using AIR-Q laryngeal mask airway: A case report. World J Clin Cases, 2022.PMID 35582056