Abstract
BackgroundAwake craniotomy requires specific sedation procedure in an awake patient who should be able to cooperate during the intraoperative neurological assessment. Currently, limited number of literatures on the application of high-flow nasal cannula (HFNC) in the anesthetic management for awake craniotomy has been reported. Hence, we carried out a prospective study to assess the safety and efficacy of humidified high-flow nasal cannula (HFNC) airway management in the patients undergoing awake craniotomy.MethodsSixty-five patients who underwent awake craniotomy were randomly assigned to use HFNC with oxygen flow rate at 40 L/min or 60 L/min, or nasopharynx airway (NPA) device in the anesthetic management. Data regarding airway management, intraoperative blood gas analysis, intracranial pressure, gastric antral volume, and adverse events were collected and analyzed.ResultsPatients using HFNC with oxygen flow rate at 40 or 60 L/min presented less airway obstruction and injuries. Patients with HFNC 60 L/min maintained longer awake time than the patients with NPA. While the intraoperative PaO2 and SPO2 were not significantly different between the HFNC and NPA groups, HFNC patients achieved higher PaO2/FiO2 than patients with NPA. There were no differences in Brain Relaxation Score and gastric antral volume among the three groups as well as before and after operation in any of the three groups.ConclusionHFNC was safe and effective for the patients during awake craniotomy.Trial registrationChinese Clinical Trial Registry, CHiCTR1800016621. Date of Registration: 12 June 2018.
Highlights
Awake craniotomy requires specific sedation procedure in an awake patient who should be able to cooperate during the intraoperative neurological assessment
There was no significant difference in age, gender ratio, Body mass index (BMI), presence of epilepsy or hypertension, and types of surgery among three groups (Table 1)
Brain relaxation score and gastric antral volume There were no differences in Brain Relaxation Score at the end of the dura suspension and during the period of cortical functional mapping among the three groups (Table 4)
Summary
Awake craniotomy requires specific sedation procedure in an awake patient who should be able to cooperate during the intraoperative neurological assessment. A series of venting devices including nasal cannula [2], simple facemask [3], bilateral nasopharyngeal [4], laryngeal mask [5], and endotracheal tube [6] have been used in the awake craniotomy When these methods were applied, the patient’s head is fixed during the surgical procedure, and potential laryngospasm or cough occur when the patient is awake, which may result in surgical bleeding, increased intracranial pressure or neurological injury. Endotracheal intubation or laryngeal mask, and a deeper grade of sedation/anesthesia (BIS value at 40–60) are required for the patients to prevent coughing and laryngospasm. Some patients may have difficulty in tolerating the nasopharyngeal or oropharyngeal airways or feel uncomfortable due to the dry airway
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