Our Summary

This research paper is about a study that was done to see if it’s safe to not use invasive blood pressure monitoring during a specific type of brain surgery called an “awake craniotomy,” in which the patient is awake while a brain tumor is removed. Invasive blood pressure monitoring involves inserting a tube into a blood vessel, which can be risky. In this study, instead of invasive monitoring, the patients’ blood pressure was checked non-invasively (without inserting anything into the body) every few minutes during the surgery and then every 15 minutes for four hours after surgery.

The study was done at a large hospital, where 74 of these surgeries were performed with non-invasive blood pressure monitoring. A variety of patients were included, with some having pre-existing health conditions such as diabetes or heart disease, and some being smokers or taking blood pressure medication.

During the surgeries, some patients needed medication to either raise or lower their blood pressure. There were two complications: one patient had a type of stroke during surgery, and another patient had a heart issue a week after surgery. However, there were no other complications related to anesthesia, bleeding, kidney function, or heart and lung function.

The researchers concluded that it’s not necessary to routinely use invasive blood pressure monitoring during this type of brain surgery, as it didn’t seem to make a difference in controlling the patient’s bodily functions during surgery or in preventing complications at the surgical site.

FAQs

  1. What is the main purpose of the study on “awake craniotomy”?
  2. What alternative method was used in the study instead of invasive blood pressure monitoring during the surgery?
  3. What did the researchers conclude about the necessity of invasive blood pressure monitoring during an awake craniotomy?

Doctor’s Tip

A helpful tip a doctor might give a patient undergoing a craniotomy is to discuss the monitoring options for blood pressure during the surgery. They may explain the benefits and risks of invasive versus non-invasive monitoring and reassure the patient that non-invasive monitoring can be just as effective in ensuring their safety during the procedure. It’s important for the patient to feel informed and comfortable with the monitoring plan in place for their surgery.

Suitable For

Patients who are typically recommended for a craniotomy include those with brain tumors, aneurysms, arteriovenous malformations, traumatic brain injuries, and other brain disorders that require surgical intervention. In the case of an awake craniotomy, patients with tumors located in areas of the brain responsible for speech, movement, or other important functions may be recommended for this type of surgery. Additionally, patients who may not tolerate general anesthesia well or who need to be awake during surgery for neurological testing may also be candidates for an awake craniotomy. It is important for patients to be thoroughly evaluated by a neurosurgeon and anesthesiologist to determine if a craniotomy is the best course of treatment for their specific condition.

Timeline

Before the craniotomy:

  • The patient undergoes pre-operative testing and evaluation to assess their overall health and suitability for surgery.
  • The patient may meet with various healthcare providers, including neurosurgeons, anesthesiologists, and nurses, to discuss the procedure and address any concerns.
  • The patient may need to stop taking certain medications or adjust their diet in preparation for surgery.
  • The patient may undergo imaging tests, such as MRI or CT scans, to provide detailed information about the brain tumor.
  • The patient may receive instructions on what to expect before, during, and after the surgery.

After the craniotomy:

  • The patient is monitored closely in the recovery room to ensure they are stable and recovering well from the surgery.
  • The patient may experience pain, swelling, and discomfort at the surgical site, which can be managed with medication.
  • The patient may need to stay in the hospital for a few days for observation and recovery.
  • The patient will have follow-up appointments with their healthcare team to monitor their progress and discuss any concerns or complications.
  • The patient may need physical therapy or rehabilitation to regain strength and function after surgery.
  • The patient will be advised on post-operative care, including wound care, medication management, and activity restrictions.
  • The patient may undergo follow-up imaging tests to assess the success of the surgery and monitor for any recurrence of the brain tumor.

What to Ask Your Doctor

Here are some questions a patient may want to ask their doctor about craniotomy:

  1. Is invasive blood pressure monitoring necessary for my specific type of craniotomy surgery?
  2. What are the potential risks and benefits of using invasive blood pressure monitoring during my surgery?
  3. How often will my blood pressure be checked during and after the surgery if non-invasive monitoring is used?
  4. What alternative monitoring methods are available if invasive blood pressure monitoring is not used?
  5. How will my pre-existing health conditions, such as diabetes or heart disease, affect the decision to use invasive blood pressure monitoring?
  6. What medications may be needed to manage my blood pressure during the surgery if invasive monitoring is not used?
  7. What are the potential complications that could arise from not using invasive blood pressure monitoring during my surgery?
  8. How will the decision to use or not use invasive blood pressure monitoring affect my recovery time and overall outcome of the surgery?
  9. Are there any specific factors about my case that make using invasive blood pressure monitoring more or less necessary?
  10. Can I have a second opinion or speak to another specialist about the decision to use invasive blood pressure monitoring during my craniotomy surgery?

Reference

Authors: Florman JE, Rughani AI, Kizor R, Pardi G, England E, Brown E. Journal: World Neurosurg. 2022 Dec;168:e350-e353. doi: 10.1016/j.wneu.2022.10.021. Epub 2022 Oct 8. PMID: 36220493