Awake Craniotomy Using Dexmedetomidine Infusion and Scalp Block: Our Experience in Series of Cases

Abstract

BACKGROUND: Awake craniotomy is an important technique used for brain tumour excision from eloquent cortex. Awake craniotomy allows maximum resection of the tumor with minimum functional impairment. The critical aspect is to maintain adequate analgesia and sedation, hemodynamic stability, airway safety, while keeping the patient awake and cooperative for neurological testing. AIM OF THE STUDY: We are reporting cases series of awake craniotomy under monitored anesthesia care using dexmedetomidine infusion as an adjuvant to scalp block, titrating the sedation level by BIS monitoring. MATERIALS AND METHODS: After careful patient selection and psychological preparation Monitored Anesthesia Care was provided by continuous infusion of dexmedetomidine at a rate of 0.2-0.5ug/kg/min titrating sedation score to BIS value of 70-90. Bilateral scalp block was administered using 0.5% bupivacaine. For dura mater incision, a pad with 2% lidocaine was applied for 3 minutes. The tumor removal was complete with no neurological deficiency. All the patients were discharged on 5 th postoperative day without complications and with full patient satisfaction. CONCLUSION: We conclude that monitored anesthesia care with dexmedetomidine infusion and scalp block for awake craniotomy is safe and efficacious. Absence of complications and high patient satisfaction score makes this technique close to an ideal technique for awake craniotomy.