Dr. Jonathan Myers, Dr. Deepak Sharma University of Washington, Department of Anesthesiology and Pain MedicineBackground: Neurosurgical treatment of some brain tumors and epileptogenic foci require a unique anesthetic... [ view full abstract ]
Dr. Jonathan Myers, Dr. Deepak Sharma
University of Washington, Department of Anesthesiology and Pain Medicine
Background: Neurosurgical treatment of some brain tumors and epileptogenic foci require a unique anesthetic management that allows for awakening the patient during surgery and testing of neurological function. This “asleep-awake-asleep” anesthesia makes possible functional mapping that allows resection of the tumor / epileptogenic focus while minimizing loss of neurological function. Prior studies of anesthetic regimens for awake craniotomies at our institution utilizing a propofol infusion and an unprotected airway have reported infrequent complications, however, the incorporation of laryngeal mask airway (LMA) devices and new anesthetic drugs has resulted in a broadening of anesthetic techniques for these procedures.
Methods: We performed a retrospective review of 115 awake craniotomy procedures utilizing a variety of anesthetic regimens and either an unprotected airway throughout or an LMA intermittently. Anesthetic records were analyzed for intraoperative complications including hemodynamic instability, airway compromise, seizures, bleeding, stroke and death. Chart review was performed to assess post-operative complications and surgeon satisfaction.
Results: Complications were uncommon, featuring limited seizures, brain swelling, airway obstruction requiring additional management, and a single incidence of aspiration. The patient who aspirated was able to complete intraoperative language mapping, was treated for an aspiration pneumonitis and discharged without requiring further treatment or follow-up. A general assessment of surgeon satisfaction revealed a single instance in which functional mapping was not possible due to a lack of patient cooperation.
Discussion: Compared to prior studies at our institution, evolving anesthetic regimens and techniques do not appear to lead to an increase in complications or contribute to poor clinical outcomes. In fact, the ASA status and number of comorbidities has increased in the patient population undergoing this procedure at our institution, making a more tailored approach necessary. The availability of additional regimens and airway devices are likely contributors to maintaining a low incidence of complications in an increasingly complex patient population.
