Sewell, Darreul;
Smith, Martin;
(2019)
Awake craniotomy: anesthetic considerations based on outcome evidence.
Current Opinion in Anaesthesiology
, 32
(5)
pp. 546-552.
10.1097/ACO.0000000000000750.
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Abstract
Purpose of reviewThis review highlights anaesthesia management options for awake craniotomy and discusses the advantages and disadvantages of different approaches, intraoperative complications and future directions.Recent findingsFor lesions located within or adjacent to eloquent regions of the brain, awake craniotomy allows maximal tumour resection with minimal consequences on neurological function. Various techniques have been described to provide anaesthesia or sedation and analgesia during the initial craniotomy, and rapid return to consciousness for intraoperative testing and tumour resection; there is no evidence that one approach is superior to another. Although very safe, awake craniotomy is associated with some well recognized complications; most are minor and self-limiting or easily reversed. In experienced hands, failure of awake craniotomy occurs in fewer than 2% of cases, irrespective of anaesthesia technique. Although brain tumour surgery remains the most common indication for awake craniotomy, the technique is finding utility in other neurosurgical procedures.SummarySeveral anaesthetic approaches are available for the management of patients during awake craniotomy. The choice of technique should be based on individual patient factors, location and duration of surgery, and anaesthesiologist expertise and experience. Appropriate patient selection and excellent multidisciplinary team working is associated with high levels of procedural success and patient satisfaction.
| Type: | Article |
|---|---|
| Title: | Awake craniotomy: anesthetic considerations based on outcome evidence |
| Location: | United States |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1097/ACO.0000000000000750 |
| Publisher version: | https://doi.org/10.1097/aco.0000000000000750 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | Science & Technology, Life Sciences & Biomedicine, Anesthesiology, awake craniotomy, brain tumour, complications, conscious sedation, dexmedetomidine, BRAIN-TUMOR RESECTION, SAME-DAY DISCHARGE, SURGERY, DEXMEDETOMIDINE, GLIOMA, PROPOFOL, SEDATION, BENEFITS |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > UCL BEAMS UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science > Dept of Med Phys and Biomedical Eng |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10206094 |
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