Abstract
Anesthesiologists should supply proper sedation and high-quality awakening in awake craniotomy anesthesia. At our institution, we perform an asleep-awake-asleep technique for awake craniotomy anesthesia by using short-acting anesthetic drugs, such as propofol and remifentanil. However, elderly patients do not wake adequately in our normal protocol and hence are unable to complete the required neurological tasks. In this case series, we present the anesthetic management of three elderly patients with sequent use of propofol and dexmedetomidine as sedative agents for awake craniotomy. We hypothesized that this anesthetic protocol is advantageous in awake craniotomy management. For the awake phase, all patients were adequately awake and performed neurological tasks without adverse events and agitation. The use of dexmedetomidine sequentially with propofol in an asleep-awake-asleep technique for awake craniotomy in elderly patients might shorten the time to awakening and provide clear awakening.
Highlights
In anesthesia for awake craniotomy (AC), proper sedation and high-quality awakening are required for patients to properly perform neurological tasks during surgery
Propofol and remifentanil are short-acting anesthetic drugs, and we generally use them for the high-quality wakefulness without agitation
Most of the patients undergoing AC are generally younger than 65 years in other institutions; in our institution, we sometimes experience a case over 65 years when a patient’s anesthetic management will not be problematic In elderly patients or patients with mild cognitive impairment, we sometimes experience poor awakening by using this protocol and need to manage more delicately
Summary
In anesthesia for awake craniotomy (AC), proper sedation and high-quality awakening are required for patients to properly perform neurological tasks during surgery. We perform the asleep-awake-asleep (AAA) anesthetic method using the combination of propofol and remifentanil. With this anesthetic protocol, we often experience poor quality awakening or uncontrollable agitation in the early awake phase, especially in elderly patients (i.e., patients over 65 years of age). We concluded that these phenomena are apparently caused by relative propofol excess, since it is difficult to adjust the dose of propofol for high-quality awakening.
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