Our Summary

This research paper is a review of recent clinical studies about the best ways to manage anesthesia during awake craniotomy (AC), a type of brain surgery where the patient is awake. The authors looked at English articles published between 2007 and 2015, focusing on studies that reported how anesthesia was used during AC and its effects on several outcomes like seizures, lack of oxygen, high blood pressure, nausea and vomiting, neurological problems, conversion to general anesthesia, and failure of AC.

The study included 47 articles, which used different anesthesia techniques: 18 used the asleep-awake-asleep (SAS) method, 27 used monitored anesthesia care (MAC), one used both, and one used the awake-awake-awake (AAA) technique. They found that the rates of AC failure, seizures during surgery, new neurological problems, and conversion to general anesthesia were 2%, 8%, 17%, and 2%, respectively.

There were no significant differences in these outcomes between the SAS and MAC techniques, except for the conversion to general anesthesia. However, this result should be taken with caution because it is based on one retrospective study with a high risk of bias, and the significance disappeared in an analysis of only prospectively conducted studies.

In conclusion, the authors found that both SAS and MAC techniques are feasible and safe for AC, but there is not enough data on the AAA technique. They recommend that large, randomized controlled trials are needed to determine which anesthesia method is superior for AC.

FAQs

  1. What is the focus of the clinical studies reviewed in this research paper?
  2. What were the results of the comparison between the asleep-awake-asleep (SAS) method and monitored anesthesia care (MAC) in awake craniotomy (AC)?
  3. What is the recommendation of the authors regarding the anesthesia methods used in awake craniotomy (AC)?

Doctor’s Tip

One helpful tip a doctor might tell a patient about craniotomy is to follow their anesthesia team’s instructions closely before the surgery. This may include fasting before the procedure, stopping certain medications, and following any other pre-operative guidelines provided. Proper preparation can help ensure a successful surgery and reduce the risk of complications.

Suitable For

Patients who are typically recommended for craniotomy include those with brain tumors, epilepsy, vascular malformations, traumatic brain injury, and other conditions that require surgical intervention in the brain. Awake craniotomy may be recommended for patients who need to be monitored for language or motor function during surgery, or for those who have tumors located in critical areas of the brain. The decision to perform awake craniotomy is made on a case-by-case basis by a multidisciplinary team of healthcare providers, including neurosurgeons, anesthesiologists, and neurologists.

Timeline

Before the craniotomy:

  1. Patient undergoes preoperative evaluation and discussion with the surgeon about the procedure.
  2. Patient may undergo imaging tests such as MRI or CT scans to plan the surgery.
  3. Patient may need to stop taking certain medications or undergo other preoperative preparations.

During the craniotomy:

  1. Patient is given anesthesia and sedatives before the surgery begins.
  2. Patient may be awake during certain parts of the surgery to help the surgeon map out important brain areas.
  3. Anesthesia is carefully managed to ensure the patient is comfortable and pain-free throughout the procedure.

After the craniotomy:

  1. Patient is monitored closely in the recovery room for any complications or signs of infection.
  2. Patient may experience some pain or discomfort at the surgical site, which can be managed with medications.
  3. Patient will be given instructions for postoperative care, including wound care, activity restrictions, and follow-up appointments.
  4. Patient may need rehabilitation therapy to regain strength and function after the surgery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about craniotomy may include:

  1. What type of anesthesia will be used during my awake craniotomy procedure?
  2. What are the potential risks and side effects associated with the anesthesia used for awake craniotomy?
  3. How will the anesthesia be monitored during the surgery?
  4. What measures will be in place to manage any potential complications during the awake craniotomy procedure?
  5. What is the likelihood of needing to convert to general anesthesia during the procedure?
  6. How will pain and discomfort be managed during and after the surgery?
  7. What is the expected recovery process after an awake craniotomy procedure?
  8. What are the potential long-term effects of undergoing a craniotomy surgery?
  9. Are there any lifestyle changes or restrictions I should be aware of following the surgery?
  10. Are there any additional resources or support services available for patients undergoing craniotomy surgery?

Reference

Authors: Stevanovic A, Rossaint R, Veldeman M, Bilotta F, Coburn M. Journal: PLoS One. 2016 May 26;11(5):e0156448. doi: 10.1371/journal.pone.0156448. eCollection 2016. PMID: 27228013