Inflammatory Profile of Awake Function-Controlled Craniotomy and Craniotomy under General Anesthesia

Markus Klimek,Stephan Wens,Arnaud J Vincent,Jaap W Hol,Sjoerd Niehof,Claudia Heijmans-Antonissen,Jan Klein,Freek J Zijlstra

doi:10.1155/2009/670480

Markus Klimek, Stephan Wens + Show 6 more

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https://doi.org/10.1155/2009/670480

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Abstract

Background. Surgical stress triggers an inflammatory response and releases mediators into human plasma such as interleukins (ILs). Awake craniotomy and craniotomy performed under general anesthesia may be associated with different levels of stress. Our aim was to investigate whether those procedures cause different inflammatory responses. Methods. Twenty patients undergoing craniotomy under general anesthesia and 20 patients undergoing awake function-controlled craniotomy were included in this prospective, observational, two-armed study. Circulating levels of IL-6, IL-8, and IL-10 were determined pre-, peri-, and postoperatively in both patient groups. VAS scores for pain, anxiety, and stress were taken at four moments pre- and postoperatively to evaluate physical pain and mental duress. Results. Plasma IL-6 level significantly increased with time similarly in both groups. No significant plasma IL-8 and IL-10 change was observed in both experimental groups. The VAS pain score was significantly lower in the awake group compared to the anesthesia group at 12 hours postoperative. Postoperative anxiety and stress declined similarly in both groups. Conclusion. This study suggests that awake function-controlled craniotomy does not cause a significantly different inflammatory response than craniotomy performed under general anesthesia. It is also likely that function-controlled craniotomy does not cause a greater emotional challenge than tumor resection under general anesthesia.

Highlights

General anesthesia using endotracheal intubation is the standard procedure during brain tumor resection
The total amount of propofol administered throughout the operation was significantly less in the awake group than in the general anesthesia group
There are studies that establish a clear relationship between dynamic IL-6 changes and cortisol plasma levels during the perioperative period [11, 23]

Summary

Introduction

General anesthesia using endotracheal intubation is the standard procedure during brain tumor resection. The cerebral cortex of the patient is electrically stimulated This allows the surgeon to properly identify and spare functionally relevant areas of the brain. By allowing for maximal tumor excision while keeping healthy tissue intact, awake craniotomy has the potential for better patient outcomes [1] In such a procedure, the need to provide sufficient analgesia and sedation without interfering with electrophysiological monitoring is essential [2]. Awake craniotomy and craniotomy performed under general anesthesia may be associated with different levels of stress. This study suggests that awake function-controlled craniotomy does not cause a significantly different inflammatory response than craniotomy performed under general anesthesia. It is likely that function-controlled craniotomy does not cause a greater emotional challenge than tumor resection under general anesthesia

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Results

Conclusion