Our Summary

This research paper reviews the latest trends in the way anesthetics are managed during awake brain surgery (craniotomy). Two methods are commonly used for anesthesia - one involves putting the patient to sleep, waking them up, and then putting them back to sleep again; the other involves closely monitoring the anesthesia. Both methods have been equally effective for mapping the brain during surgery. The choice of method depends on the anesthesiologist’s preference.

A drug called Dexmedetomidine has shown to be very effective and safe for awake craniotomy and is now considered a good alternative to another drug, propofol. Despite the use of local anesthesia and painkillers, pain is still a common complaint during awake brain surgery. However, the right surgical strategies can reduce pain and even prevent complications after surgery.

The usefulness of using anticonvulsants to prevent seizures during surgery is still uncertain, but a drug called levetiracetam may be better than others for this purpose. With advances in anesthetic management, awake craniotomies, once a rare procedure, are now commonly performed. Modern anesthesia techniques can almost always successfully map the brain. Further research is needed to manage awake craniotomies in high-risk patients.

FAQs

  1. What are the current trends in anesthetic management for awake craniotomy?
  2. What are the potential advantages of using Dexmedetomidine in awake craniotomy procedures?
  3. How can the management of pain be improved during awake craniotomy procedures?

Doctor’s Tip

One helpful tip a doctor might tell a patient about craniotomy is to discuss and plan for the anesthesia approach with their medical team beforehand. This includes understanding the options for sedation, pain management, and prevention of intraoperative complications. Additionally, discussing any concerns or fears about being awake during the procedure can help alleviate anxiety and ensure a smoother experience. It is important for patients to trust their medical team and communicate openly to ensure the best possible outcome.

Suitable For

Patients who are typically recommended for craniotomy include those with brain tumors, epilepsy, vascular malformations, traumatic brain injury, and other neurological conditions that require surgical intervention. Awake craniotomy may be recommended for patients who need intraoperative brain mapping, language or motor function testing, or tumor resection in eloquent areas of the brain. Additionally, patients who are at high risk for general anesthesia, such as those with significant medical comorbidities, may also be recommended for awake craniotomy.

Timeline

Before craniotomy:

  • Patient undergoes preoperative evaluation and imaging studies to determine the need for surgery
  • Anesthesia team meets with the patient to discuss the procedure and plan for awake craniotomy
  • Patient may undergo scalp block or other preoperative pain management techniques
  • Patient is brought into the operating room and positioned for surgery
  • Anesthesia team administers sedation and monitors the patient’s vital signs throughout the procedure

After craniotomy:

  • Patient wakes up during the procedure and may be asked to perform tasks to aid in brain mapping
  • Anesthesia team continues to monitor the patient’s vital signs and pain levels
  • Surgical team completes the procedure and closes the incision
  • Patient is transferred to the recovery room for further monitoring
  • Patient may experience postoperative pain and discomfort, which is managed with pain medications
  • Patient is discharged from the hospital once stable and able to resume normal activities

Overall, the patient undergoes a comprehensive preoperative evaluation, undergoes the awake craniotomy procedure with appropriate anesthesia and pain management, and receives postoperative care to ensure a successful recovery.

What to Ask Your Doctor

  1. What are the risks and benefits of undergoing a craniotomy procedure?
  2. What is the specific reason for recommending a craniotomy in my case?
  3. What are the expected outcomes and recovery time following a craniotomy?
  4. What type of anesthesia will be used during the craniotomy procedure?
  5. Will I be awake during the surgery, and if so, what can I expect during the awake portion of the procedure?
  6. What pain management options will be available during and after the craniotomy?
  7. How will my vital signs be monitored during the procedure to ensure my safety?
  8. What is the experience of the surgical and anesthesia team in performing craniotomy procedures?
  9. What are the potential complications or side effects associated with a craniotomy?
  10. Are there any alternative treatment options to consider before moving forward with a craniotomy?

Reference

Authors: Kulikov A, Lubnin A. Journal: Curr Opin Anaesthesiol. 2018 Oct;31(5):506-510. doi: 10.1097/ACO.0000000000000625. PMID: 29994938