Anesth Analg 2006;102:882-887
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ane.0000196721.49780.85
NEUROSURGICAL ANESTHESIA
Anesthetic Complications of Awake Craniotomies for Epilepsy Surgery
Andrius P. Skucas, MD, and
Alan A. Artru, MD
Department of Anesthesiology, University of Washington, School of Medicine, Seattle, Washington
Address correspondence and reprint requests to Andrius P. Skucas, MD, Department of Anesthesiology, Box 356540, University of Washington, School of Medicine, Seattle, WA 98195-6540. Address e-mail to askucas{at}u.washington.edu.
Awake craniotomies are often performed for resection of epileptogenic foci close to vital areas of the brain. For awake craniotomies at our institution, propofol is infused during local anesthetic injection and craniotomy, spontaneous ventilation is preserved, and no endotracheal tube or laryngeal mask airway is used. Propofol is discontinued for language, motor, and/or sensory mapping and for electrocorticography. Patients are re-sedated with propofol for resection and closure. We performed a retrospective chart review of 332 propofol-based "asleep-awake-asleep" (AAA) techniques with unsecured airways and 129 general anesthesia with endotracheal intubation craniotomies for epilepsy surgery. We compared the incidence of intraoperative respiratory and hemodynamic complications and incidence of seizures, nausea, brain swelling, patient movement, bleeding, aspiration, air embolism, and death. Airway compromise was uncommon in AAA cases and although incidences of hypertension, hypotension, and tachycardia were statistically increased in AAA versus general anesthesia craniotomy, these were treated appropriately. In only one patient the use of our AAA technique may have contributed to a poor clinical outcome.
This article has been cited by other articles:
|
