Safe Removal Research Articles

Comparing the outcomes of termination of second trimester pregnancy with a live fetus using intravaginal misoprostol between women with and without previous cesarean section

ObjectiveTo compare the outcomes of termination of pregnancy with live fetuses in the second trimester (14–28 weeks), using misoprostol 400 mcg intravaginal every 6 h, between women with previous cesarean section (PCS) and no previous cesarean section (no PCS).MethodsA comparative study was conducted on a prospective database of pregnancy termination in the second trimester, Chiang Mai university hospital. Inclusion criteria included: (1) singleton pregnancy; (2) gestational age between 14 and 28 weeks; and (3) pregnancy with a live fetus and medically indicated for termination. The participants were categorized into two groups; PCS and no PCS group. All were terminated using misoprostol 400 mcg intravaginal every 6 h. The main outcomes were induction to fetal delivery interval and success rate, defined as fetal delivery within 48 h.ResultsA total of 238 women, including 80 PCS and 158 no PCS, were recruited. The success rate of fetal delivery within 48 h between both groups was not significantly different (91.3% vs. 93.0%; p-value 0.622). The induction to fetal delivery interval were not significantly different (1531 vs. 1279 min; p-value > 0.05). Gestational age was an independent factor for the success rate and required dosage of misoprostol. The rates of most adverse effects of misoprostol were similar. One case (1.3%) in the PCS group developed uterine rupture during termination, ending up with safe and successful surgical removal and uterine repair.ConclusionIntravaginal misoprostol is highly effective for second trimester termination of pregnancy with PCS and those with no PCS, with similar success rate and induction to fetal delivery interval. Gestational age was an independent factor for the success rate and required dosage of misoprostol. Uterine rupture could occur in 1.3% of PCS, implying that high precaution must be taken for early detection and proper management.SynopsisIntravaginal misoprostol is highly effective for termination of second trimester pregnancy with a live fetus, with a comparable success rate between women with and without previous cesarean section, with a 1.3% risk of uterine rupture among women with previous cesarean section.

A Method for Efficient De-identification of DICOM Metadata and Burned-in Pixel Text.

De-identification of DICOM images is an essential component of medical image research. While many established methods exist for the safe removal of protected health information (PHI) in DICOM metadata, approaches for the removal of PHI "burned-in" to image pixel data are typically manual, and automated high-throughput approaches are not well validated. Emerging optical character recognition (OCR) models can potentially detect and remove PHI-bearing text from medical images but are very time-consuming to run on the high volume of images found in typical research studies. We present a data processing method that performs metadata de-identification for all images combined with a targeted approach to only apply OCR to images with a high likelihood of burned-in text. The method was validated on a dataset of 415,182 images across ten modalities representative of the de-identification requests submitted at our institution over a 20-year span. Of the 12,578 images in this dataset with burned-in text of any kind, only 10 passed undetected with the method. OCR was only required for 6050 images (1.5% of the dataset).

Generation Mechanism of Hydroxyl Free Radicals in Micro–Nanobubbles Water and Its Prospect in Drinking Water

Micro–nanobubbles (MNBs) can generate ·OH in situ, which provides a new idea for the safe and efficient removal of pollutants in water supply systems. However, due to the difficulty in obtaining stable MNBs, the generation efficiency of ·OH is low, and the removal efficiency of pollutants cannot be guaranteed. This paper reviews the application research of MNB technology in water security from three aspects: the generation process of MNBs in water, the generation rule of ·OH during MNB collapse, and the control mechanisms of MNBs on pollutants and biofilms. We found that MNB generation methods are divided into chemical and mechanical (about 10 kinds) categories, and the instability of the bubble size restricts the application of MNB technology. The generation of ·OH by MNBs is affected by the pH, gas source, bubble size, temperature, and external stimulation. And the pH and external stimulus have more influence on ·OH generation in situ than the other factors. Adjusting the pH to alkaline or acidic conditions and selecting ozone or oxygen as the gas source can promote ·OH generation. MNB collapse also releases a large amount of energy, during which the temperature and pressure can reach 3000 K and 5 Gpa, respectively, making it efficient to remove ≈90% of pollutants (i.e., trichloroethylene, benzene, and chlorobenzene). The biofilm can also be removed by physical, chemical, and thermal effects. MNB technology also has great application potential in drinking water, which can be applied to improve water quality, optimize household water purifiers, and enhance the taste of bottled water. Under the premise of safety, after letting people of different ages taste water samples, we found that compared with ordinary drinking water, 85.7% of people think MNB water is softer, and 73.3% of people think MNB water is sweeter. This further proves that MNB water has a great prospect in drinking water applications. This review provides innovative theoretical support for solving the problem of drinking water safety.

Floating Aquatic Macrophytes in Wastewater Treatment: Toward a Circular Economy

Floating aquatic macrophytes have a high level of proficiency in the removal of various contaminants, particularly nutrients, from wastewater. Due to their rapid growth rates, it is imperative to ensure the safe removal of the final biomass from the system. The ultimate macrophyte biomass is composed of lignocellulose and has enhanced nutritional and energy properties. Consequently, it can serve as a viable source material for applications such as the production of bioenergy, fertilizer and animal feed. However, its use remains limited, and in-depth studies are scarce. Here, we provide a comprehensive analysis of floating aquatic macrophytes and their efficacy in the elimination of heavy metals, nutrients and organic pollutants from various types of wastewater. This study offers a wide-ranging scrutiny of the potential use of plant biomasses as feedstock for bioenergy generation, focusing on both biochemical and thermochemical conversion processes. In addition, we provide information regarding the conversion of biomass into animal feed, focusing on ruminants, fish and poultry, the manufacture of fertilizers and the use of treated water. Overall, we offer a clear idea of the technoeconomic benefits of using macrophytes for the treatment of wastewater and the challenges that need to be rectified to make this cradle-to-cradle concept more efficient.

Extracorporeal Removal of Per- and Polyfluoroalkyl Substances by Hemoadsorption: In vitro Kinetic Model

Introduction: Per- and polyfluoroalkyl substances (PFAS) are known water pollutants leading to potential public health consequences. High blood levels of PFAS have been associated with several pathological conditions including testicular and kidney cancer. Classic extracorporeal therapies have demonstrated limited efficiency, and new approaches should be explored. In this study, we studied the possible role of hemoadsorption to achieve a fast, safe, and effective removal of PFAS from blood in patients with high blood levels. Methods: We developed an in vitro model of hemoadsorption to test the potential of PFAS removal by extracorporeal treatment. We recirculated a highly polluted batch of water (4 L) through a sorbent cartridge (Jafron Medical, Zhuhai, China) for 120 min at a flow of 150 mL/min. We collected samples at different time points and analyzed 39 different PFAS compounds. Results: For the PFAS compounds with concentrations significantly above normal, we observed a removal ratio close to 90% already within the first 60 min of circulation leading to almost complete elimination of all pollutants at 120 min. Conclusions: The in vitro model of hemoadsorption suggests the possible application in vivo of this technique to reduce/normalize the concentrations of PFAS in patients exposed to water or environmental pollution.

Ectopic epipericardial fat necrosis: a case report

BackgroundEpipericardial fat necrosis (EFN) is a rare disease in which local inflammation and necrosis occur in the adipose tissue surrounding the heart, particularly epicardial fat. Few cases of EFN in which surgical resection was performed have been reported. We report a case of EFN after surgical resection of a right extrapulmonary tumor, in which a malignant disease could not be excluded.Case presentationA 75-year-old male patient presented with fever and chest pain. A contrast-enhanced computed tomography scan of the chest revealed a lesion, 53 × 48 mm in size, with mixed fatty density spanning the middle and lower lobes of the right lung. Thoracic magnetic resonance imaging (MRI) revealed a mass with mixed fat and soft tissue density in the same area; the lesion was contiguous with pericardial fatty tissue. The tumor was diagnosed as a liposarcoma or teratocarcinoma based on imaging results; however, the possibility of lung cancer could not be excluded. Finally, EFN was diagnosed based on the postoperative histopathological examination. The patient underwent surgical resection of the suspected right extrapulmonary tumor. The intraoperative findings revealed a mediastinal mass contiguous with pericardial fat located between the middle and lower lobes. Intraoperative pathological examination of the lesion was performed using a needle biopsy; however, no definitive diagnosis was made. The tumor may have invaded the middle lobe of the right lung, and partial resection of the right lower lobe was performed in addition to resection of the middle lobe of the right lung. The patient was followed up every 3 months without adjuvant therapy. No recurrence was reported at 1 year after surgery.ConclusionEFN should be considered in the differential diagnosis of an extrapulmonary tumor when continuity with the pericardial space is observed on MRI or other imaging studies. Surgical resection is useful in the diagnosis and treatment of EFNs. Preoperative three-dimensional reconstructive imaging and MRI should be used to identify vascular structures and confirm the continuity of the lesion with the surrounding tissues to ensure safe and rapid tumor removal.

Comparative evaluation of incidence of dentinal defects after root canal preparation using three different endodontic retreatment systems - An in vitro study.

Safe and efficient removal of all root filling materials from the root canal system without compromising radicular dentin structure is essential for optimal nonsurgical retreatment. The aim of this study was to evaluate and compare the incidence of dentinal defects caused during root canal filling removal using conventional, rotary, and reciprocating retreatment file systems. A detailed protocol explaining purpose and procedures of the study was submitted to the Institutional Ethics Committee and ethical clearance obtained. Sixty human maxillary permanent central incisors were collected and decoronated to 12-mm standardized length. The canals prepared up to a master apical file size F3 with Protaper hand files, obturated using AH plus sealer, examined under the stereomicroscope (×40 magnification): Group I: Control (n = 15), Group II: Conventional (n = 15), Group III: Protaper Universal Retreatment Files (n = 15), and Group IV: Reciproc Blue (n = 15). After instrumentation, teeth were sectioned at 3, 6, and 9 mm from the apex to evaluate the presence of dentinal defects under the stereomicroscope. Statistics were performed using the SPSS, version, 25 (SPSS Inc., Chicago, IL, USA). Initially, normality test was done using the Shapiro-Wilk test and data were not normally distributed followed by Kruskal-Wallis test. P < 0.05 is considered statistically significant. Maximum percentage increase in dentinal defects was observed in Protaper Universal Retreatment Files followed by Conventional method and Reciproc Blue. Significantly Reciproc Blue reduced the incidence of dentinal defects after root canal preparation.

Assessing the feasibility of laser ablation coating removal (LACR) on legacy bridge steel: Coating removal and adhesion, and effects on mechanical properties

The application of protective organic coatings is one of the most effective and commonly used corrosion mitigation strategies. To maintain the protective nature of coatings on long-term-exposed surfaces such as steel bridge components, coatings must be periodically removed and reapplied. A relatively new method called laser ablation coating removal (LACR), which incorporates a high energy nanosecond pulsed laser beam in combination with a high efficiency filtration system, allows for safe and effective removal of coatings and contamination from metal surfaces. In this study, LACR cleaning is tested on legacy bridge steel components to investigate the effect on substrate cleanliness and steel mechanical properties. These bridge sections were never blasted and contain a 20–100 μm thick mill-scale layer (iron oxide) below several coating layers (including lead-rich coatings). The top micron of the oxide layer is melted by LACR and also thermally insulates the underlying steel and prevents any melting within the metallic substrate. The resulting surfaces are analyzed using microscopy, hardness testing, tensile, and fatigue testing, and it is shown that LACR does not cause any measurable detrimental effects to the bulk mechanical properties of the bridge steel, as well as effectively removes all paint coatings. Furthermore, adhesion testing on LACR-cleaned substrates shows excellent adhesion, qualifying above adhesion requirements for coated steel.

A stable, non-emulsifying, regenerable ionic liquid-based extraction system for safe removal of perfluorooctanoic acid from water

The main sources of polyfluoroalkyl substances (PFAS) in the environment are industrial plants at which PFAS are manufactured or used. PFAS are released from such plants in wastewater, which must be effectively decontaminated to prevent PFAS contaminating the environment. In this study, perfluorooctanoic acid (PFOA) was extracted from model aqueous solutions using a novel ionic liquid (IL) [trihexyltetradecylphosphonium][perfluotooctanoic acid] ([P6,6,6,14][PFOA]) without an emulsification problem. Liquid–liquid extraction using the IL removed 99.7% of the PFOA from a 2000 mg/L PFOA solution after 3–6 h of mixing. The IL was easily regenerated and reused, but some of the IL was lost after multiple extraction and regeneration cycles. Immobilization of the [P6,6,6,14][PFOA] IL in a poly(vinylidene fluoride-co-hexafluoropropylene) membrane system prevented the loss of the IL. The [P6,6,6,14][PFOA]/membrane system removed 79%–85% of the PFOA from a solution containing 100 mg/L PFOA solution after 24 h of mixing. The IL immobilized in the membrane system could be regenerated by washing the system with 0.25 mol/L NaOH and could be reused multiple times giving extraction efficiencies of 72%–77%.

Inferior Vena Cava Filter Retrieval: Simple to Complex.

Retrievable inferior vena cava filters were designed to provide mechanical prophylaxis from pulmonary embolism with the intent for retrieval once no longer indicated, and have been utilized at a high rate since their introduction. Unfortunately, retrieval rates have historically lagged behind, in part due to significant rates of failed standard retrieval techniques for filters with prolonged dwell time. Refinement in advanced retrieval techniques has now allowed (in experienced centers) for safe removal of filters previously considered irretrievable. An individualized approach is necessary for each potential advanced filter retrieval to determine appropriate course of action. This review will emphasize complex filter retrieval techniques amidst a larger discussion of inferior vena cava filters and their management.

The use of Microsurgical Exploration of the External Carotid Artery for Removal of a Retained Microcatheter After Middle Meningeal Artery Embolization Using Live Fluoroscopy: A Technical Note

Fragmentation, disconnection, or entrapment of an in-use microcatheter during neuro-endovascular procedures is a known risk. Often a benign entity, retained catheters are not infrequently observed, but severe complications including thrombus, thromboembolic events, pseudoaneurysm, and limb ischemia have been described, necessitating retrieval. This technical case report demonstrates the safe use of an external carotid artery (ECA) approach for ligation and removal of a retained microcatheter after middle meningeal artery (MMA) embolization. This article also demonstrates the use of live intraoperative fluoroscopy as a surgical adjunct to ensure that the catheter is fully removed without any injury, shearing, or breakage during removal. A 66-year-old male patient presented with bilateral subdural hematomas to an outside hospital. He subsequently underwent evacuation of the hematomas followed by a right-sided MMA embolization, complicated by Onyx (Medtronic, Minneapolis, MN) entrapment of the microcatheter in the MMA. The patient was asymptomatic, but there was significant concern about continuing antiplatelet/anticoagulation therapy in the presence of the subdural hematoma. We proceeded with an open surgical approach for catheter retrieval. As the catheter was withdrawn, intraoperative fluoroscopy demonstrated complete removal without any retained fragments. The patient recovered without event and was discharged on postoperative day 1. On follow-up the patient continued to do well without any complications from the fragment that remained in the external carotid circulation. This case and accompanying video demonstrates the effective use of open ECA surgical approach to retrieve the retained microcatheter after an MMA embolization. This approach allowed for safe and effective removal of the microcatheter while significantly reducing complication risks.

Awake brain mapping by direct cortical stimulation; technical note to get higher resection rate and low morbidity in low-grade glioma patients.

Direct cortical stimulation has been used for brain mapping and localization of eloquent areas in awake patients. This simplified technique is to provide the positive areas, which can be preserved if the tumor or lesions are involved eloquent areas. The main objective of this study is to determine whether direct cortical stimulation in awake brain mapping for low-grade glioma patients increases the rate of resection or not. The authors present a retrospective study between 2020 to 2022 that includes 35 cases in a single center, to get higher resection rate, and their consequences in awake craniotomy in low-grade glioma patients. Here, two neurosurgeons were involved and the minimum follow-up was 12 months. The authors achieved 80% removal of tumors. To get higher resection rate we emphasized negative mapping with prior anatomical analysis to understand functional realignment. Stimulation-related complications will be thoroughly discussed with a potential future direction to minimize the issues. The authors used PROMIS score to measure patients physical and mental health status and kernofsky score to measure performance status before and after successful surgery. The authors found three cases of transient deficit in repetitive stimulation. Repeated stimulation to identify the eloquent areas with low voltage frequency is a good option. Numbness in the face related to stimulation may continue for 6 weeks. Functional realignment in shifted brain and edema can be seen while doing cortical and subcortical stimulation. Most of the stimulation from low to high for language mapping may vary from patient to patient. For safe removal of low-grade glioma a steep learning curve is needed to find out the negative areas, though the authors emphasize positive mapping of areas to secure the maximum eloquence.

Endoscopic Mucosal Incision to Remove a Chain of Magnets Completely Embedded under the Gastric Mucosa: A Case Report

AbstractThe rising use of electronic toys containing magnets has led to an increased incidence of magnet ingestion in children. While endoscopic extraction is the preferred approach in these cases, challenges arise when multiple magnets get swallowed, which can erode through the mucosal surface and become embedded in fibrous tissue. Extraction using simple endoscopic techniques and instruments is not possible in such cases and many times, surgical intervention becomes necessary.This case showcases the application of cap-assisted endoscopic mucosal resection and endoscopic submucous dissection principles and the use of magnetic forceps, enabling the safe and complete removal of the embedded magnet pieces and highlighting the remarkable effectiveness of advanced endoscopic techniques in managing this unique challenge. The multidisciplinary approach and tailored interventions demonstrated in this case underscore the importance of prompt and comprehensive evaluation in cases of ingested foreign bodies, particularly those involving multiple magnets

Synthesis and ecotoxicity screening of reusable, magnetically harvestable metal oxide/hydroxide nanocomposites for safe and sustainable removal and recovery of phosphorus from wastewater

This study assesses the ecotoxicological hazard and suggests measures to improve the ecosafety of 10 highly-efficient metal oxide/hydroxide nanocomposite adsorbents for phosphorus removal/recovery from wastewater using the marine bacterium Vibrio fischeri - an ecotoxicological test organism commonly used for the screening of chemicals which is especially sensitive to zinc. Nanocomposites were synthesized through simple co-precipitation of two-, three- and four-valent metal precursors (Ca2+, Mg2+, Zn2+, Fe3+, Zr4+) at different molar ratios, and characterized with laser diffraction, ICP-OES, XRD and SEM. Among these, the pilot-scale tested ZnFeZr-6:1:1-oxyhydroxide was modified by reducing the zinc-fraction to minimize the leaching of harmful Zn2+. The presence of Zn, however, makes the materials technologically powerful by improving the adsorbent selectivity towards phosphate and the material reusability. Composites stability (d50 < 10 μm) was investigated in deionized water and 2% NaCl (V. fischeri test medium) addressing agglomeration, settling and solubilization (releasing metal ions and/or potentially hazardous nanoparticles). All composites, their filtered supernatants and precursor metal salt solutions were evaluated for their toxic potency (half-effective concentration, EC50 and minimum bactericidal concentration, MBC) using 30-min kinetic bioluminescence inhibition test (ISO-21338:2010) and 24-h viability assay with bacteria V. fischeri. Only the Zn-containing composites showed inhibitory effects to Vibrio fischeri. Those with highest zinc-fraction (ZnFeZr-18:5:1; ZnFeZr-10:1:1) were classified “harmful” (EC50 < 100 mg/L), thus environmentally unsafe for engineering applications. The ZnFeZr-6:1:1 (EC50 = 118 mg/L, MBC = 250 mg/L) proved assumingly safe once deposited on magnetic particles ZnFeZr-6:1:1@MPs (EC50 = 1123 mg/L, MBC > 1000 mg/L). All other composites without Zn were non-toxic to Vibrio fischeri.

Evaluation of the Calibration Curve of Water Content Sensors in Iron Ore Tailings

Evaluation of the Calibration Curve of Water Content Sensors in Iron Ore Tailings

(053) Penile Entrapment Due to Metal Constriction Rings: Removal, Recovery and Complications

Abstract Introduction Penile incarceration due to a metal constriction ring is a rare urologic emergency. Improper ring sizing, use of makeshift rings or prolonged length of use can cause penile/penoscrotal entrapment with resulting sequelae including genital ischemia, necrosis, and urinary retention. Metal rings are prone to this exigent situation, as they tend to be denser and thicker than typical constriction rings which presents a challenge for safe removal. Objective We aim to report a multi-institutional experience characterizing the presentation, removal methods, and outcomes after prolonged penile entrapment in patients with metal constriction rings. Methods We performed a retrospective chart review from 2000 to 2023 at participating institutions to identify men presenting with penile incarceration due to metal constriction ring use using the following ICD-10 codes: S30.842A, S30.843, W49.04XA, S31.24X, and T19.4. Operative/procedural tools and duration were recorded from the initial emergency room encounter and follow-up notes were reviewed for any subsequent complications. Results Twelve patients with median age 55 with interquartile range (IQR) of 26 were identified (Table 1). The metal rings varied in size, and most were composed of stainless steel. The length of time the constriction ring was in place before seeking medical attention ranged from 3 hours to 10 days with a median time of 42 hours, (IQR, 60). Removal instruments included a powered drill cutting tool, ring cutter, and bolt cutters. Median operative/procedural time was 90 minutes (IQR, 63). Cool irrigation was used in all cases where powered rotary cutting tool was used in combination with a mechanism to protect the underlying skin such as a metal retractor. Additionally, a barrier such as saline-soaked towels and/or lubricating jelly was used to protect the surrounding skin during operative intervention with a powered tool. Most patients reported full recovery despite prolonged entrapment; however, one patient developed a urethrocutaneous fistula and one patient reported diminished erectile function. Interestingly, one patient with concomitant substance abuse and vasoconstrictive agents use presented with penile skin necrosis requiring concurrent debridement which was further complicated by Fournier’s gangrene 1 month later in the setting of continued substance use and non-adherence to prescribed antibiotics. Conclusions Penile incarceration by metal constriction ring is a rare urologic emergency. This study represents the first multi-institutional and largest investigation evaluating the management of this condition. Manual and powered cutting tools are effective in removing metal constriction rings. If powered tools are employed, irrigation and retractors are necessary to prevent thermal injury. Despite most patients fully recovering after removal, significant complications have been observed. Therefore, prompt management and proper follow-up are recommended. Disclosure No.

Measurement and removal of asbestos in residential dwellings to be demolished-urban transformation experience in Izmir, Turkey.

Asbestos has been used extensively in the construction industry for its superior insulation properties before its health hazards were discovered and its use eventually banned. It is likely that many residential buildings built before the 2000s in Turkey contain asbestos. Therefore, it is important to raise awareness of the potential danger of asbestos exposure during demolition work and to identify asbestos-containing materials and ensure their safe removal and disposal. This study is executed to determine the residential dwellings containing asbestos in Izmir, Turkey. The research included field studies to determine asbestos presence in the buildings that were damaged during the 2020 earthquake. Air measurements and bulk samples were taken from 50 buildings that would go through the demolition process. Eleven buildings were found to contain asbestos which corresponds to 22%. The detected asbestos type was 60% chrysotile (white asbestos). Results could be helpful for future demolition work, which are conducted in the same region that includes buildings with similar properties. Also, it is expected that the database created for this study could be useful in other studies in Turkey, where accurate statistical data related with asbestos measurements is essentially non-existent.

Evaluation of the automated dispensing cabinets users' level of satisfaction and the influencing factors in Al-Ahsa hospitals.

The objective of the current study is to evaluate how healthcare practitioners are satisfied with ADCs and scrutinize some influencing factors that could affect this satisfaction. A cross-sectional survey study was designed and distributed online to healthcare providers in Al-hasa hospitals. A total of 166 participants. Regarding the frequency and pattern of ADC use, around 79.5% used ADC and 85.4% were informed about using ADC on a daily basis. As for the level of satisfaction with ADC, an exact 81.9% gave a high rate for overall satisfaction, 81.3% were highly satisfied with the system's accuracy, and 74.7% were highly satisfied with the time it takes to complete the task. Regarding usability of the system, 69.8% thought it was easy whereas 36.8% agreed that the time required for reloading medication is longer than before ADC. Furthermore, 79.5% agreed that ADC allowed them to accomplish their job safely, and 67.4% agreed that it improved their productivity. Regarding challenges, 74.7% agreed that all drawer types assure safe access and removal of medications, and 18.7% agreed that there is a significant potential for loss of data. This study investigated healthcare staff's perceptions and satisfaction with ADCs in Al-hasa hospitals. The healthcare participants were mostly highly satisfied with the use of the ADCs which translated into better patient care and improved patient safety as well as higher productivity.

Attenuation of decabromodiphenyl ether (BDE209) using Ag/Fe0 complexed with citrate in various environmental and toxicity assessments by evaluating ryegrass

Utilizing the Ag/Fe0 and citrate complex for the efficient and safe removal of BDE209.

Anestezija za kraniotomiju u budnom stanju - principi izvođenja

Awake craniotomy is a neurosurgical procedure that is used for the safe removal of intracranial lesions near Broca's and Wernicke's speech areas. During this procedure, speech mapping is done. Its use demands anesthesia for awake craniotomy, which includes different possibilities for the management of anesthesia with awake patients at the moment of tumor removal. There are two widely accepted concepts: "awake-awake-awake", when the patient is consciously sedated ("awake") throughout surgery, with lighter or deeper sedation (monitored anesthesia care), or "asleep-awake-asleep", when the patient is introduced into general endotracheal anesthesia while opening the skull, but is awake during lesion removal and asleep during closure. Our protocol is a form of "asleep-awake" concept, with general endotracheal anesthesia for craniotomy and awake patients during and after lesion removal (including skull closure).