Awake craniotomy for tumor resection
A 25-year-old female patient weighing 49 kg had severe headache of 1 month duration. Examination of cranial nerves and sensorimotor function of the limbs were normal. On perioperative evaluation, the airway was normal, mallampati was class I, and neck movement was within normal limits. She didn’t have any abnormal anatomical picture or no restriction in jaw joints’ movement. Heart and lung examination were normal. Patient's GCS was 15/15 and cranial nerves examinations were normal. Laboratory studies, including CBC, BUN, Cr, Na, K, BS, PT, PTT, INR, were normal and her blood group A+. Any abnormality couldn’t be seen on the chest radiography.\nWhen the patients were visited in preoperative anesthesia clinic being awake during surgery, type of anesthesia, surgery and the need of patient cooperation was described for them even if it was hard for them. Without prescription of premedication, we got electrocardiogram, pulse oximetery, non-invasive blood pressure NIBP. Under regional anesthesia, we got arterial line for continuous checking of blood pressure. Then we started invasive blood pressure IBP monitoring, and catheterized their bladder. Before starting sensory nerve block, first 1 micg/kg fentanyl and then 25 mg propofol was injected. Scalp nerves block include supraorbital, supra-auricular, lesser and greater occipital with 0.5% marcaine plus epinephrine 1/200,000 was done. The area that pins fixed head separately was infiltrated by lidocaine 2%. Continuous CO2 sampling via nasal canola was done. Oxygen 6 L/min was established through a face mask. To avoid fatigue and discomfort, shoulders, arms, and lower extremities were supported through pillows. Then, continuous intravenous infusion of remifentanil 0.3 micg/kg was started. For sedation, a bolus dose of propofol 1 mg/kg was infused and continued by infusion at 30 micg/kg/min. We didn’t carry out monitoring of bispecteral index due to proximity to the surgical side and the need to sterilize skin on the forehead. During the surgery, systolic BP of 56-year-old patient at 110-150 mmHg and 25-year-old patient at 100-130 mmHg was retained. Respiration in 56-year-old patient at 10-15/min and 25-year-old patient at 9-15/min was retained. In both the patients, ET CO2 was maintained at 32-40 mmHg and during surgery, pulse oximetery was maintained at 97-100%. During surgery, for removing lesion, the patients were awake and obeyed the surgeon's commands and moved their limbs and fingers. After removal of the lesion, the patient was asleep, dura matter was sutured. The bone of head was placed and scalp was sutured. The patients, after removing the fixative pin of head slowly woke up, without any unexpected problem.