Awake craniotomy. Considerations in special situations

• Published in: Revista española de anestesiología y reanimación Vol. 60; no. 7; p. 392
• Main Authors: Solera Ruiz, I, Uña Orejón, R, Valero, I, Laroche, F
• Format: Journal Article
• Language: Spanish
• Published: Spain 01.08.2013
• Subjects: Adult; Airway Management - methods; Analgesics, Non-Narcotic - administration & dosage; Analgesics, Non-Narcotic - pharmacokinetics; Antibiotic Prophylaxis; Child; Conscious Sedation; Craniotomy - methods; Deep Brain Stimulation - methods; Dexmedetomidine - administration & dosage; Dexmedetomidine - pharmacokinetics; Humans; Hypnotics and Sedatives - administration & dosage; Hypnotics and Sedatives - pharmacokinetics; Narcotics - therapeutic use; Nerve Block - methods; Neurosurgical Procedures - methods; Patient Selection; Preoperative Care; Scalp; Wakefulness; Functional neurosurgery; Neurocirugía con el paciente despierto; Neuroanestesiología; Awake craniotomy; Awake neurosurgery; Neurocirugía funcional; Intraoperative neurophysiological monitoring; Craneotomía con el paciente despierto; Monitorización neurofisiológica intraoperatoria; Neuroanesthesiology
• ISSN: 2340-3284
• DOI: 10.1016/j.redar.2013.01.001

Awake craniotomy was the earliest surgical procedure known, and it has become fashionable again. In the past it was used for the surgical management of intractable epilepsy, but nowadays, its indications are increasing, and it is a widely recognized technique for the resection of mass lesions involving the eloquent cortex, and for deep brain stimulation. The procedure is safe, provides excellent results, and saves money and resources. The anesthesiologist should know the principles underlying neuroanesthesia, the technique of scalp blockade, and the sedation protocols, as well as feeling comfortable with advanced airway management. The main anesthetic aim is to keep patients cooperating when required (analgesia-based anesthesia). This review attempts to summarize the most recent evidence from the clinical literature, a long as the number of patients undergoing craniotomies in the awake state are increasing, specifically in the pediatric population.