Awake craniotomy with dexmedetomidine during resection of brain tumours located in eloquent regions.
Background: An awake craniotomy (AC) is the gold standard for the resection of supratentorial brain tumours in eloquent areas. Intraoperative monitoring "on-demand" of essential eloquent brain functions and the increasing need to preserve higher intellectual functions during surgery requires a uniqu...
| Publicado en: | Anaesthesiology Intensive Therapy / Anestezjologia, Intensywna Terapia Vol. 54; no. 5; pp. 347 - 357 |
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| Autores principales: | , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Termedia Publishing House
2022
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=161636805&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 161636805 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 16425758 8Z8J jtl: Anaesthesiology Intensive Therapy / Anestezjologia, Intensywna Terapia issn: 16425758 maglogo: N pubinfo: dt: 2022 vid: 54 iid: 5 pid: 24295 pub: Termedia Publishing House place: , <Blank> artinfo: ui: 161636805 161636805 161636805 10.5114/ait.2022.123151 161636805 ppf: 347 ppct: 10 formats: tig: atl: Awake craniotomy with dexmedetomidine during resection of brain tumours located in eloquent regions. aug: au: Lechowicz-Głogowska, Bogusława Ewa Uryga, Agnieszka Weiser, Artur Salomon-Tuchowska, Beata Burzyńska, Małgorzata Fortuna, Wojciech Kasprowicz, Magdalena Tabakow, Paweł affil: Department of Anaesthesiology and Intensive Care, Wroclaw Medical University, Wroclaw, Poland sug: subj: Wakefulness Craniotomy Imidazoles Administration and Dosage Brain Neoplasms Surgery Conscious Sedation Anesthesia Methods Human Prospective Studies Evoked Potentials, Motor Evoked Potentials, Auditory, Brainstem Patient Safety Scales Psychological Tests Monitoring, Physiologic Infusions, Intravenous ab: Background: An awake craniotomy (AC) is the gold standard for the resection of supratentorial brain tumours in eloquent areas. Intraoperative monitoring "on-demand" of essential eloquent brain functions and the increasing need to preserve higher intellectual functions during surgery requires a unique anaesthetic approach during AC. Dexmedetomidine is considered the first-choice pharmacological agent for sedation during AC. Methods: Twenty-six patients with a single brain tumour located in areas of eloquent brain function were enrolled in this prospective study. The patients underwent AC under conscious sedation. Motor-evoked potentials and brainstem-evoked auditory potentials were measured using neurophysiological tests during surgery to assess brain potentials. Intraoperative brain relaxation was reached using a modified Bristow scale. Neuromonitoring and psychological tests were maintained until meningeal closure. Results: All operations were carried out successfully, and no reoperations were needed. No significant impact on circulatory and respiratory parameters was observed during conscious sedation based on dexmedetomidine. Neither instrumental airway support nor conversion to general anaesthesia was necessary. Brain relaxation was good in 84% of cases. Intraoperative epileptic episodes were observed in 15% of the patients. Neurological and psychological monitoring was satisfactory. Unaltered muscle force was observed postoperatively in 88% of the patients. Conclusions: AC performed under conscious sedation, and dexmedetomidine infusion without instrumental airway support, was safe and well-tolerated by patients with comfortable physiological sleep for most of the procedure. This approach to AC was associated with minimal risk of perioperative adverse events and may be particularly beneficial in patients with severe comorbidities. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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