Anesthetic Management for Awake Craniotomy

DOI 33 References
  • SATO Kiyotaka
    Department of Anesthesiology, Kinki University School of Medicine Department of Neuroanesthesia, Kohnan Hospital
  • Artru Alan A.
    Department of Anesthesiology, Washington University School of Medicine
  • SHIOKAWA Yasuhiro
    Department of Anesthesiology, Kinki University School of Medicine
  • KOGA Yoshihisa
    Department of Anesthesiology, Kinki University School of Medicine

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  • これからの脳外科麻酔の方向性―麻酔科医の描く将来像―Ａｗａｋｅ　ｃｒａｎｉｏｔｏｍｙの麻酔

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To minimize post-operative neurological deficit, awake craniotomy, in which the patient is awaken and brain function is mapped, is chosen when the lesion is located near the eloquent area. The points for the management of awake craniotomy are airway management, control of grand mal seizure and psychological support. A deeper relationship with the patient is required. For the precise monitoring of ECoG and brain functional mapping, all sedatives should be avoided before the procedure. In the OR, the patient is positioned laterally or semilaterally and the airway secured. Propofol infusion is titrated for sedation and analgesia by local anesthetics should be elaborate for painful craniotomy. Recently introduced anesthetics, remifentanil and dexmedetomidine, and improvement of airway devices are making this type of surgery safe and comfortable.

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