Feasibility of awake craniotomy in the pediatric population

Abstract

exposure to the SARS-Corona virus due to aerosol generation were much lower with suction, administration of oxygen, or manual ventilation compared to airway intubation. 3 We therefore suggest that natural airway sedation is an attractive option in some of these patients, and sedation/anesthesia providers should consider the option of natural airway sedation for imaging and other minor procedures rather than general endotracheal anesthesia in order to reduce aerosol particle generation during the COVID-19 pandemic. Monitoring via nasal cannula with end-tidal CO2 (EtCO2) detection capacity should still be used and a regular isolation mask applied to over this nasal cannula. Other advantages that associated with this technique in well-organized sedation programs include shorter duration of sedation, faster recovery, and prompt discharge of the patient which ultimately results in decreased exposure of staff to the patient and lower healthcare cost and resource utilization. 4 Furthermore, we advocate for a telehealth prescreening evaluation and subsequent multi-disciplinary discussion among the sedation team to ensure optimal patient selection and risk stratification. We suggest the exclusion of high-risk patients such as those with difficult airways, respiratory distress, copious secretions, American Society of Anesthesiologists-Physical Status classification >3, and history of previous anesthesiology consultation. We also urge anesthesia/sedation providers to strictly adhere to guidelines from the Centers for Disease Control (endorsed by ASA, AANA, APSF) on PPE, N95, and other institution dependent infection control measures to decrease transmission of COVID-19 even if natural airway sedation is performed. 5