Preliminary evaluation of ketofol-based sedation for awake craniotomy procedures

Abdou, Samar A.; Shehab, Hany A.; Samir, Enas M.; Eissa, Ehab Mohamed

doi:10.1016/j.egja.2010.05.005

Cited by 9 publications

(25 citation statements)

References 14 publications

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“…The detailed screening, eligibility assessment and inclusion process is shown in Fig 1 . We included a total of forty-seven studies [ 10 , 17 – 62 ] in our SR. One author was personally contacted, and provided us more information about their used anaesthesia technique [ 10 ].…”

Section: Resultsmentioning

confidence: 99%

“…Data of the study characteristics are shown in Table 1 . A total of fourteen case series [ 10 , 17 , 19 , 20 , 23 , 28 , 39 , 41 , 44 , 47 , 51 , 53 , 54 , 60 ] thirteen prospective studies [ 18 , 21 , 22 , 25 – 27 , 30 , 33 , 35 , 38 , 52 , 55 , 61 ], seventeen retrospective studies [ 24 , 29 , 31 , 34 , 37 , 40 , 42 , 43 , 45 , 46 , 48 – 50 , 57 – 59 , 62 ], two RCTs [ 32 , 56 ], and one pseudo-RCT [ 36 ] comprising 5945 AC procedures in 5931 patients were analysed ( Table 1 ). Of note, during the data extraction process it appeared that nine studies [ 20 , 22 , 27 , 31 , 42 – 46 ] partially repor...…”

Section: Resultsmentioning

confidence: 99%

“…We divided the identified records into three subtopics according to the used anaesthetic technique: Nineteen studies reported the asleep-awake-asleep (SAS) respectively sleep-awake (SA) technique [ 20 – 23 , 25 – 27 , 37 – 39 , 44 – 46 , 50 , 51 , 53 , 56 , 57 , 60 ], twenty-eight reported monitored anaesthesia care (MAC) [ 10 , 17 – 19 , 24 , 28 – 32 , 34 – 36 , 40 – 43 , 47 – 49 , 52 , 54 , 55 , 58 – 62 ] and one used the awake-awake-awake (AAA) technique [ 33 ]. Of note, Souter et al have used the SAS as well as the MAC technique in their patients [ 60 ].…”

Section: Resultsmentioning

confidence: 99%

“…Defined by the "American Society of Anesthesiologists" (ASA) this technique enables purposeful patient response to tactile or verbal stimulation, while preserving spontaneous ventilation without any airway instrumentation [ 8 ]. Twenty-eight included studies reported the successful use of MAC in AC [ 10 , 17 – 19 , 24 , 28 – 32 , 34 – 36 , 40 – 43 , 47 – 49 , 52 , 54 , 55 , 58 – 62 ]. Except of three studies, which only used local infiltration anaesthesia [ 36 , 48 , 61 ] respectively one, which did not mention the use of infiltration anaesthesia [ 17 ], all others applied an additional RSNB at the beginning of the surgery.…”

Section: Resultsmentioning

confidence: 99%

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Anaesthesia Management for Awake Craniotomy: Systematic Review and Meta-Analysis

et al. 2016

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BackgroundAwake craniotomy (AC) renders an expanded role in functional neurosurgery. Yet, evidence for optimal anaesthesia management remains limited. We aimed to summarise the latest clinical evidence of AC anaesthesia management and explore the relationship of AC failures on the used anaesthesia techniques.MethodsTwo authors performed independently a systematic search of English articles in PubMed and EMBASE database 1/2007-12/2015. Search included randomised controlled trials (RCTs), observational trials, and case reports (n>4 cases), which reported anaesthetic approach for AC and at least one of our pre-specified outcomes: intraoperative seizures, hypoxia, arterial hypertension, nausea and vomiting, neurological dysfunction, conversion into general anaesthesia and failure of AC. Random effects meta-analysis was used to estimate event rates for four outcomes. Relationship with anaesthesia technique was explored using logistic meta-regression, calculating the odds ratios (OR) and 95% confidence intervals [95%CI].ResultsWe have included forty-seven studies. Eighteen reported asleep-awake-asleep technique (SAS), twenty-seven monitored anaesthesia care (MAC), one reported both and one used the awake-awake-awake technique (AAA). Proportions of AC failures, intraoperative seizures, new neurological dysfunction and conversion into general anaesthesia (GA) were 2% [95%CI:1–3], 8% [95%CI:6–11], 17% [95%CI:12–23] and 2% [95%CI:2–3], respectively. Meta-regression of SAS and MAC technique did not reveal any relevant differences between outcomes explained by the technique, except for conversion into GA. Estimated OR comparing SAS to MAC for AC failures was 0.98 [95%CI:0.36–2.69], 1.01 [95%CI:0.52–1.88] for seizures, 1.66 [95%CI:1.35–3.70] for new neurological dysfunction and 2.17 [95%CI:1.22–3.85] for conversion into GA. The latter result has to be interpreted cautiously. It is based on one retrospective high-risk of bias study and significance was abolished in a sensitivity analysis of only prospectively conducted studies.ConclusionSAS and MAC techniques were feasible and safe, whereas data for AAA technique are limited. Large RCTs are required to prove superiority of one anaesthetic regime for AC.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Anaesthesia Management for Awake Craniotomy: Systematic Review and Meta-Analysis

et al. 2016

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“…Recently, it was demonstrated that “ketofol”, delivered as an infusion for deep sedation in the operating room, appears to be a safe and effective anesthetic technique [ 7 ]. Furthermore, during awake craniotomies, “ketofol” provided hemodynamic stability without intraoperative episodes of increased intracranial pressure [ 8 ]. In addition, “ketofol” infusion in a critical care and procedural setting has demonstrated a number of benefits including airway preservation, maintenance of spontaneous respiration, hemodynamic stability, analgesia, and rapid recovery [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Period Prevalence of Ketamine-Propofol Admixture “Ketofol” in the Operating Room among Anesthesia Providers at an Academic Medical Center

et al. 2015

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BackgroundThe primary aim of this study was to determine the period prevalence of the single-syringe ketamine-propofol admixture used for sedation and induction among anesthesia providers during a 5-year period before and after educational sessions addressing barriers to its use. Secondary aims were to determine barriers to its use and address the most prevalent concerns through educational sessions.Material/MethodsSurveys were administered to certified and student registered nurse anesthetists, anesthesia residents, and anesthesiologists at Mayo Clinic Rochester, MN before and after educational sessions addressing common barriers. Identified barriers were addressed by oral and/or electronic presentations with identical content.ResultsPre-education period prevalence for sedation was 110 (43%) and 64 (25%) for induction. Identified barriers were uncertainty of benefit in 62 respondents (23%), mixed controlled substance disposal in 48 (18%), regulatory/institutional policies in 20 (7%), and compatibility in 9 (3%). Post-education period prevalence for sedation was 102 (44%), and induction 63 (27%). No concerns were noted in 72% of the post-education group verses 42% in the pre-education group (p<0.01). No concerns were reported in 51% of the electronic only education group verses 64% in the oral education group (p<0.01).ConclusionsThe period prevalence of “ketofol” was greater for sedation than induction. The period prevalence following education showed a slight increase in both sedation and induction use. There was a significant reduction in barriers following education, with oral presentations being more effective than electronic only. Period prevalence was increasing following education; however, allowing more time may have shown a significant practice change.

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The ketamine effect on intracranial pressure in nontraumatic neurological illness

Zeiler

Teitelbaum

West

et al. 2014

Journal of Critical Care

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Preliminary evaluation of ketofol-based sedation for awake craniotomy procedures

Cited by 9 publications

References 14 publications

Anaesthesia Management for Awake Craniotomy: Systematic Review and Meta-Analysis

Anaesthesia Management for Awake Craniotomy: Systematic Review and Meta-Analysis

Period Prevalence of Ketamine-Propofol Admixture “Ketofol” in the Operating Room among Anesthesia Providers at an Academic Medical Center

The ketamine effect on intracranial pressure in nontraumatic neurological illness

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