Target‐controlled infusion of propofol and remifentanil combined with bispectral index monitoring for awake craniotomy

Hans, Pol; Bonhomme, Vincent; Born, Jochen; Noordhoudt, A. Maertens de; Brichant, Jean-François; Dewandre, Pierre-Yves

doi:10.1046/j.1365-2044.2000.01277.x

Cited by 102 publications

(54 citation statements)

References 12 publications

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“…In our case series the level of sedation during Dexmedetomidine infusion was monitored by BIS index, maintained BIS score between 70-90 by increasing level of sedating during positioning and head pin fixation and reducing it during testing for functional area intraoperatively. 12 …”

Section: Discussionmentioning

confidence: 99%

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

B¹,

P²,

Muralikrishna³

2015

jemds

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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.

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Section: Discussionmentioning

confidence: 99%

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

B¹,

P²,

Muralikrishna³

2015

jemds

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“…Traditionally awake craniotomy has been performed for epilepsy surgery, which helps in better ECoG localization of the seizure focus without the influence of general anaesthetic agents.Varying anaesthetic techniques for awake craniotomy have been described in the literature [2][3][4][5][6][7]. One is using skull block along with conscious sedation.…”

Section: Discussionmentioning

confidence: 99%

“…Intraoperative neurological testing allows optimal tumour resection with minimal postoperative neurological dysfunction. Different anaesthetic techniques for awake craniotomy have been described in the literature [2][3][4][5][6][7]. Some have used conscious sedation, while others have used 'asleep-awake-asleep' technique.…”

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confidence: 99%

Awake Craniotomy for Tumour Excision

Prabhakaran

Mohan

Tripathy

et al. 2008

Medical Journal Armed Forces India

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A wake craniotomy literally means performing a craniotomy on an awake patient. It allows A A intraoperative assessment of the patient's neurological status. It is mainly used for mapping the resection margins during epilepsy surgery, accurate location of electrodes in surgery for movement disorders, and excision of tumours from eloquent areas of the cortex [1]. Eloquent areas are specialized areas of brain which control important functions, like movement, sensation, speech etc. Intraoperative neurological testing allows optimal tumour resection with minimal postoperative neurological dysfunction. Different anaesthetic techniques for awake craniotomy have been described in the literature [2][3][4][5][6][7]. Some have used conscious sedation, while others have used 'asleep-awake-asleep' technique. This is the first case series of awake craniotomies published from the Indian armed forces. Material and MethodsThis procedure was carried out in Command Hospital (SC), Pune during the ten month period. The inclusion criteria were supra tentorial, intra-axial tumours located close to eloquent areas of the brain and patients willing to co-operate. The exclusion criteria was posterior fossa tumours, non-willing patients, large tumours with midline shift and raised intracranial tension. Confused, demented or agitated patients are poor candidates. Patient was assessed for his fitness and psychological make up to undergo awake craniotomy. After history and physical examination the patient was subjected to detailed counselling. Patient was explained about the advantages of remaining awake during operation and the sequence of events in the operation theatre. Patient was educated about different tasks like moving the toes/ fingers on command, identification of picture cards, speaking etc. which he was supposed to perform during the surgery. It was re-emphasized that he will be conscious and he had to lie down still during the surgery. Option of general anaesthesia was also kept open and an informed consent was taken.In the operation theatre intravenous line was started and sedation in the form of injection midazolam 1-2 mg and injection fentanyl 50-75 mcg was given. The scalp was painted with 10% betadine lotion. The supraorbital,supratrochlear, auriculotemporal, zygomaticotemporal, greater occipital and lesser occipital nerves (Fig. 1) were blocked bilaterally with local anaesthetic (LA) solution.We used a mixture of 20 ml of 0.5% bupivacaine, 20 ml of 2% plain lignocaine, 0.4 ml (400 mcg) of adrenaline and 40 ml of saline adding upto a total of 80 ml of solution. This solution has a concentration of 0.125% bupivacaine, 0.5% of lignocaine and 5 mcg/ml of adrenaline. Adrenaline helps in hemostasis, reduces absorption of LA, thereby reducing its toxicity and prolongs the duration of action. About 25-30 ml of this solution was used for the nerve blocks. A band (Fig. 2) of subcutaneous and subfascial injection was given with 20-25 ml of this solution, around the head passing above the ears through forehead and occiput [8]. The rema...

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“…It can reduce the incidence of respiratory depression 25 . BIS values correlated better with the level of consciousness than effect-site concentration of propofol during target-controlled infusion of propofol and remifentanil used for awake craniotomy 26 . In patients on antiepileptic medications there maybe delay in increase in BIS value with increase in level of consciousness, hence in these patients BIS values must be interpreted cautiously 27 .…”

Section: Monitoringmentioning

confidence: 92%

Anesthesia considerations in epilepsy surgery

Shetty

Pardeshi

Shah

et al. 2016

International Journal of Surgery

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Epilepsy surgeries can be done under general anesthesia or with local anesthesia and sedation. Epilepsy surgery done under general anesthesia have similar goals as any other neurosurgical procedure, except in patients with temporal lobe epilepsy requiring cortical mapping or electrocorticography (ECoG) where depth of anesthesia has to be reduced. Since seizure focus localization can be done preoperatively with modern diagnostic tools, general anesthesia is popular even for these patients. It is comfortable for both the surgeon and the patient. For intraoperative ECoG or cortical mapping awake craniotomy is the preferred technique.

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Target‐controlled infusion of propofol and remifentanil combined with bispectral index monitoring for awake craniotomy

Cited by 102 publications

References 12 publications

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

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

Awake Craniotomy for Tumour Excision

Anesthesia considerations in epilepsy surgery

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