A RETROSPECTIVE STUDY OF 26 CASES OF ANAESTHESIA FOR AWAKE CRANIOTOMY
Journal Title: Journal of Advanced Medical and Dental Sciences Research - Year 2017, Vol 5, Issue 1
Abstract
Background: Awake craniotomy is performed for localization and resection of epileptic focus or for resection of tumours located near the eloquent areas of brain. This study was carried out to record the cases and complications occurred in awake craniotomy in 5 years. Materials & Methods: This study was conducted in the department of anesthesia in year 2010-2015. It included 26 cases of awake craniotomy over the period of 5 years. Data pertaining to pre‑anaesthetic evaluation, intraoperative management, and post‑operative course were collected. The pre‑operative data included age, sex, weight, American Society of Anesthesiologists (ASA) physical status, airway status with Mallampati (MP) grade was also noted. Intraoperative data such as anaesthetic technique and duration of surgery was recorded. The intraoperative complications such as bradycardia, tachycardia, hypotension, and hypertension, pain, hypoxia (SpO2 ≤ 90%), tight brain, seizure, cough, and any other complications were recorded. Post‑operative data such as nausea, vomiting, seizures, fever, surgical and neurological complications, progression or occurrence of new deficits, histopathological character of lesion, and duration of Intensive Care Unit and hospital stay was also recorded. Results: Out of 26 patients, 12 were males and 14 were females. The difference was statistical non significant (P-1) The mean age of male patients was 38±2.4 years and in females was 40±1.6 years. The mean weight in males was 60.24±3.2 Kg and in females was 56.08±1.7 Kg. The difference was statistical non significant (P > 0.05). ASA status 1 was seen in 17 patients and 2 in 9 patients. Right lesions were seen in 15 patients and left lesions were seen in 11 patients. 1 case of recuurent lesions was recorded. The mean duration of surgery was 246±12.6 minutes. ICU stay days were 2.4±1.3 days. Hospital stay days were 8±4 days. Propofol and fentanyl combination was the most commonly used anaesthetic regimen to provide MAC in 20 patients (propofol‑fentanyl group). Dexmedetomidine was used for conscious sedation in 6 patients. We reported intra- operative complications such as tachycardia (1) in each group. Hypertension was the most common complication recorded with Propofol and fentanyl group while no cases was seen in dexmedetomidine group. Other complications were desaturation (2), apnea (2), movement (3), tense brain (3), shivering (2) and snoring (1) in propofol‑fentanyl group. While hypotension (1), pain (1), seizures (3) and cough was seen in dexmedetomidine group. Total number of intra – operative complications such as desaturation (2), apnea (2), movement (3), tense brain (3), shivering (2) and snoring (1), hypotension (1), pain (1), seizures (3) and 6 cases of cough was seen. Conclusion: Conscious sedation is the technique of choice for awake craniotomy. For conscious sedations, Fentanyl, propofol, and dexmedetomidine are important agents used. Case selection should be carefully done. Appropriate use of sedatives or anesthetic agents is key to the success for awake craniotomy.
Authors and Affiliations
Ashish Mittal, Mridula Agarwal
Keywords
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