Abstract PR166

Abstract

Background & Objectives: The anesthetic goal for awake craniotomy is not only to maintain adequate sedation, analgesia, respiratory and hemodynamic stability but also to provide an awake yet co-operative patient for proper neurological testing. Dexmedetomidine, an a2-agonist, has advantages of being a minimal respiratory depressant with cardiac stabilization properties. We carried out an observational study to evaluate the efficacy of dexmedetomidine sedation for awake craniotomy. Materials & Methods: All patients with age more than 18yr who underwent awake craniotomy for intracranial tumor surgery were enrolled. The patients who were un-cooperative, had difficult airway and had medical conditions preventing them to lie down for many hours, were excluded. In the operating room, the patients received a bolus dose of dexmedetomidine 1µg/kg over 10min followed by an infusion of 0.2–0.7µg/kg/hr (BIS target 60–80). Once the patients were sedated, scalp block was given with bupivacaine 0.25%. The data on hemodynamics at various painful stages of the procedure, intraoperative complications, nausea/vomiting, brain bulge, seizures etc were collected. Total amount of fentanyl used, intravenous (IV) fluids required, blood loss and transfusion, duration of surgery, ICU and hospital stay were also recorded. Postoperatively, the patient’s satisfaction was assessed using numerical rating scale. Results: A total of 24 patients (18 male, 6 female) underwent awake craniotomy during a period of 20 months. The mean age and weight was 39.7±11.4yrs and 64.9±9.1kg respectively. All patients were scheduled for craniotomy and excision of left sided supratentorial tumors except for 3 patients who had right sided tumor. Most common intraoperative complication was seizures; observed in five patients (20.8%). None of these patients experienced any episode of desaturation. Two patients had tight brain for which propofol boluses were administered. The average fentanyl consumption was 161.5±85.0 µg. The duration of surgery, ICU and hospital stays were 231.5±90.5min., 14.5±3.5hrs and 4.7±1.5days, respectively. The overall patient satisfaction score was 8. Development of new neurologic deficit or worsening of the deficit occurred in six (25%) patients. Conclusion: The use of dexmedetomidine infusion with regional scalp block in patients undergoing awake craniotomy is safe and efficacious. Absence of major complications and higher patient satisfaction score makes it close to an ideal agent for craniotomy in awake state.