Anesthesia for Awake Neurosurgery

Koht, Antoun; Neuloh, Georg; Childers, Sara Jean

doi:10.1007/978-1-4614-0308-1_14

Cited by 2 publications

(1 citation statement)

References 63 publications

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“…The use of remifentanil might facilitate a smooth transition from the pre‐awake to the awake phase and provide analgesia during the awake phase; however, its potential side effects, such as respiratory depression, nausea and vomiting, may occur. Nausea and vomiting not only cause patient discomfort but also increase the risk of aspiration and consequent respiratory complications . Moreover, body movement and increased brain swelling associated with nausea and vomiting may make the surgical procedure more technically difficult .…”

Section: Introductionmentioning

confidence: 99%

Effects of low‐dose remifentanil infusion on analgesic or antiemetic requirement during brain function mapping: A retrospective cohort study

Shiraki

Goto

Fukagawa

et al. 2020

Acta Anaesthesiol Scand

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Background Pain and discomfort during the awake phase in awake craniotomy should be relieved to facilitate brain mapping. Although some anaesthesiologists use low‐dose (0.01‐0.05 µg/kg/min) remifentanil infusion to provide analgesia during this phase, its efficacy and side effects have never been evaluated. Therefore, this study primarily aimed to investigate the effects of low‐dose remifentanil infusion on the need for antiemetic treatment during brain mapping and secondarily aimed to determine its effects on the need for additional analgesic treatment. Methods This retrospective study included 218 patients who underwent awake craniotomy at our centre from 2008 to 2018. The relationship between low‐dose remifentanil infusion during the awake phase and the requirement for analgesic or antiemetic treatment was examined. A multivariable competing risk regression analysis was performed to adjust for patient and operative variables. Results Sixty‐six patients (30.3%) received low‐dose (median rate: 0.01 µg/kg/min) remifentanil infusion during the awake phase. Forty‐nine patients (22.5%) received an antiemetic and 99 (45.4%) received additional analgesic treatment. The difference in additional analgesic treatment was not significant between patients who received low‐dose remifentanil infusion and those who did not (adjusted hazard ratio: 1.13; 95% confidence interval: 0.75‐1.70; P = .570); however, the use of antiemetics significantly increased in patients who received remifentanil (adjusted hazard ratio: 1.78; 95% confidence interval: 1.01‐3.15; P = .047). Conclusion Low‐dose remifentanil infusion during the awake phase in awake craniotomy significantly increased the need for antiemetics but did not decrease the need for additional analgesic treatment.

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Section: Introductionmentioning

confidence: 99%

Effects of low‐dose remifentanil infusion on analgesic or antiemetic requirement during brain function mapping: A retrospective cohort study

Shiraki

Goto

Fukagawa

et al. 2020

Acta Anaesthesiol Scand

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Pitfalls of Anesthetic Management for Awake Craniotomy

Kamata

2015

JJSCA

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Awake craniotomy contributes the maximal surgical resection with a minimal risk of postoperative deficits when a tumor is in or adjacent to the eloquent area. Concerns about patient management during awake craniotomy include：1) keeping spontaneous respiration with an unsecured airway；2) potential risks of sudden onset nausea/vomiting and seizure；3) the need for a multimodal approach to pain；and 4) maintaining a constant level of consciousness. Awake craniotomy is still challenging for anesthesiologists, though short-acting intravenous agents and supraglottic devices are now available. From March 2000 to August 2013, we experienced 1,235 craniotomies with the use of intraoperative magnetic resonance imaging, of which 1,000 cases were surgeries for intracranial glioma. Perioperative strategy and intraoperative management of awake craniotomy are described in this article based on our experience of 333 awake surgery cases (up to October 2014) .

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Anesthesia for Awake Neurosurgery

Cited by 2 publications

References 63 publications

Effects of low‐dose remifentanil infusion on analgesic or antiemetic requirement during brain function mapping: A retrospective cohort study

Effects of low‐dose remifentanil infusion on analgesic or antiemetic requirement during brain function mapping: A retrospective cohort study

Pitfalls of Anesthetic Management for Awake Craniotomy

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