Abstract
The anesthesia for awake craniotomy (AC) is a consecrated anesthetic technique that has been perfected over the years. Initially used to map epileptic foci, it later became the standard technique for the removal of glial neoplasms in eloquent brain areas. We present an AC anesthesia technique consisting of three primordial times, called awake-asleep-awake, and their respective particularities, as well as delve into the anesthetic medications used. Its use in patients with low and high-grade gliomas was favorable for the resection of tumors within the functional boundaries of patients, with shorter hospital stay and lower direct costs. The present study aims to systematize the technique based on the experience of the largest philanthropic hospital in Latin America and discusses the most relevant aspects that have consolidated this technique as the most appropriate in the surgery of gliomas in eloquent areas.
Highlights
The anesthesia for awake craniotomy (AC) was first performed by Sir Victor Horsley, in 1886, to locate epileptic foci with the aid of cortical electrical stimulation[1]
total intravenous anesthesia (TIVA) has neuroprotective properties, reduces the intracranial pressure (ICP), cerebral blood flow (CBF), cerebral metabolic rate (CMR), and edema, as well as allowing the rapid induction and recovery, being the most used in cases of brain neoplasms[14,15]
Keeping the brain in appropriate conditions facilitates dynamic manipulation of structures, reduces intraoperative edema, and the risks in the postoperative period. This outcome was observed in a meta-analysis involving 1,819 patients undergoing elective craniotomy under TIVA, wherein in addition to increased hemodynamic stability during surgery and CBF, there were lower incidences of nausea and vomiting in the postoperative period related to cerebral edema and increased ICP
Summary
Márcio Cardoso Krambek[1,4,5] TCBC-SP2,3. ; João Luiz Vitorino-Araújo[2,3,4,5]; Renan Maximilian Lovato[2,4,5]; José Carlos Esteves Veiga, ABSTRACT. The anesthesia for awake craniotomy (AC) is a consecrated anesthetic technique that has been perfected over the years. Used to map epileptic foci, it later became the standard technique for the removal of glial neoplasms in eloquent brain areas. We present an AC anesthesia technique consisting of three primordial times, called awake-asleep-awake, and their respective particularities, as well as delve into the anesthetic medications used. Its use in patients with low and high-grade gliomas was favorable for the resection of tumors within the functional boundaries of patients, with shorter hospital stay and lower direct costs. The present study aims to systematize the technique based on the experience of the largest philanthropic hospital in Latin America and discusses the most relevant aspects that have consolidated this technique as the most appropriate in the surgery of gliomas in eloquent areas
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