TY - JOUR
T1 - Anesthesia for awake craniotomy
T2 - a how-to guide for the occasional practitioner
AU - Meng, Lingzhong
AU - McDonagh, David L.
AU - Berger, Mitchel S.
AU - Gelb, Adrian W.
N1 - Publisher Copyright:
© 2017, Canadian Anesthesiologists' Society.
PY - 2017/5/1
Y1 - 2017/5/1
N2 - Awake craniotomy (AC), defined as the performance of at least part of an open cranial procedure with the patient awake, has been tied to beneficial outcomes compared with similar surgery under general anesthesia. Improved anesthetic techniques have made a major contribution to the increasing popularity of AC. However, the heterogeneity of practice among institutions doing large numbers of ACs raises questions (often among those who only occasionally perform AC – i.e., practitioners in low-volume AC institutions) as to the ideal anesthetic technique for AC. The procedure presents a variety of decision-making dilemmas, the origins of which are the varying institutional preferences, lack of quality evidence, and several practice controversies. Evidence-based data that support a single anesthetic algorithm for AC are sparse. In this narrative review, the technical nuances of 13 aspects of anesthetic care for AC are discussed based on institutional preferences and available evidence, and the various controversies and research priorities are discussed. The skills, experience, and commitment of both the surgeon and the anesthesiologist are large variables that are likely more important than what the literature suggests about “best” techniques for AC. Optimizing patient outcome is the fundamental goal of the anesthesiologist.
AB - Awake craniotomy (AC), defined as the performance of at least part of an open cranial procedure with the patient awake, has been tied to beneficial outcomes compared with similar surgery under general anesthesia. Improved anesthetic techniques have made a major contribution to the increasing popularity of AC. However, the heterogeneity of practice among institutions doing large numbers of ACs raises questions (often among those who only occasionally perform AC – i.e., practitioners in low-volume AC institutions) as to the ideal anesthetic technique for AC. The procedure presents a variety of decision-making dilemmas, the origins of which are the varying institutional preferences, lack of quality evidence, and several practice controversies. Evidence-based data that support a single anesthetic algorithm for AC are sparse. In this narrative review, the technical nuances of 13 aspects of anesthetic care for AC are discussed based on institutional preferences and available evidence, and the various controversies and research priorities are discussed. The skills, experience, and commitment of both the surgeon and the anesthesiologist are large variables that are likely more important than what the literature suggests about “best” techniques for AC. Optimizing patient outcome is the fundamental goal of the anesthesiologist.
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U2 - 10.1007/s12630-017-0840-1
DO - 10.1007/s12630-017-0840-1
M3 - Article
C2 - 28181184
AN - SCOPUS:85011811009
SN - 0832-610X
VL - 64
SP - 517
EP - 529
JO - Canadian Journal of Anesthesia
JF - Canadian Journal of Anesthesia
IS - 5
ER -