Question

Anaesthesia management in awake craniotomy.

Hint:

Effective anesthesia management requires a balance between adequate sedation for patient comfort and the ability to maintain alertness for neurological monitoring.

Answer 1

Anaesthesia management in awake craniotomy aims to provide adequate sedation and pain control while ensuring the patient remains alert and responsive for brain mapping.
Step 1: Sedation and Analgesia:
1. Conscious Sedation: A combination of local anesthesia and sedative medications (e.g., midazolam, dexmedetomidine) is used to keep the patient relaxed but responsive.
2. Pain Control: Local anesthesia is administered to the scalp and surgical area to provide pain relief during the procedure.
3. Light Anesthesia: The anesthesia team may maintain a light level of general anesthesia if needed, to prevent discomfort but still allow the patient to cooperate with the surgical team.
Step 2: Intraoperative Monitoring:
1. Neurological Monitoring: Continuous monitoring of the patient's neurological status is essential. The patient may be asked to perform tasks such as speaking or moving to assess brain function during surgery.
2. Vital Sign Monitoring: Blood pressure, heart rate, and oxygen levels are closely monitored to ensure the patient’s safety throughout the procedure.
Step 3: Communication and Adjustments:
1. Communication with the Patient: The surgical team must communicate with the patient regularly to ensure cooperation and to assess responses to stimulation.
2. Adjusting Sedation Levels: Sedation levels may be adjusted as needed to keep the patient awake but comfortable during critical parts of the surgery.