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NEUROSURGICAL ANESTHESIA

A Retrospective Analysis of a Remifentanil/Propofol General Anesthetic for Craniotomy Before Awake Functional Brain Mapping

Departments of Anesthesiology (Neuroanesthesia) and Surgery (Neurosurgery) Duke University Medical Center

Address correspondence and reprint requests to John C. Keifer, MD, Department of Anesthesiology, Box 3094, DUMC, Durham, NC 27710. Address e-mail to keife001{at}mc.duke.edu.

We performed this study to summarize drug dosing, physiologic responses, and anesthetic complications from an IV general anesthetic technique for patients undergoing craniotomy for awake functional brain mapping. Review of 98 procedures revealed "most rapid" IV infusion rates for remifentanil 0.05, 0.05–0.09 µg · kg^–1 · min^–1 and propofol 115, 100–150 µg · kg^–1 · min^–1. The infusions lasted for 78, 58-98 min. Intraoperative emergence from general anesthesia was 9 (6–13) min after discontinuing IV infusions to allow for brain mapping and was independent of infusion duration and duration of craniotomy before mapping. Spontaneous ventilation was generally satisfactory during drug infusion, as evidenced by Sao₂ = 95% (92%–98%) and Paco₂ = 50 (47–55) mm Hg. However, we recorded at least one 30-s epoch of apnea in 69 of 96 patients. Maximum systolic arterial blood pressure was 150 (139–175) mm Hg and minimal systolic arterial blood pressure was 100 (70–150) mm Hg during drug infusion. Three patients experienced intraoperative seizures. Two patients did not tolerate the awake state and required reinduction of general anesthesia. No patients required endotracheal intubation or discontinuation of surgery. This general anesthetic technique is effective for craniotomy with awake functional brain mapping and offers an alternative to continuous wakefulness or other IV sedation techniques.

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				F. A. Lobo and P. Amorim Anesthesia for craniotomy with intraoperative awakening: how to avoid respiratory depression and hypertension? Anesth. Analg., May 1, 2006; 102(5): 1593 - 1594. [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999