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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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The asleep-awake technique for cerebral tumour surgery – aesthetic management

Anästhesiologisches Management der Schlaf-Wach-Technik in der zerebralen Tumorchirurgie

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  • presenting/speaker Florian J. Raimann - Universitätsklinikum Frankfurt am Main, Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Frankfurt am Main, Deutschland
  • Elisabeth H. Adam - Universitätsklinikum Frankfurt am Main, Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Frankfurt am Main, Deutschland; Universitätsklinikum Frankfurt am Main, Klinik für Neurochirurgie, Frankfurt am Main, Deutschland
  • Ulrich Strouhal - Universitätsklinikum Frankfurt am Main, Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Frankfurt am Main, Deutschland
  • Kai Zacharowski - Universitätsklinikum Frankfurt am Main, Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Frankfurt am Main, Deutschland
  • Volker Seifert - Universitätsklinikum Frankfurt am Main, Klinik für Neurochirurgie, Frankfurt am Main, Deutschland
  • Marie-Therese Forster - Universitätsklinikum Frankfurt am Main, Klinik für Neurochirurgie, Frankfurt am Main, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocP153

doi: 10.3205/19dgnc490, urn:nbn:de:0183-19dgnc4903

Published: May 8, 2019

© 2019 Raimann et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Awake craniotomy for cerebral tumor surgery necessitates skillful anesthetic management and experience. Rapid adjustment of sedation, adequate analgesia nd ventilation, consideration of electrophysiological monitoring and anticipation of complications are essential. This retrospective single-center study evaluates the anesthetic management for awake craniotomy applying the asleep-awake technique.

Methods: After approval of the local ethics committee, records of 62 patients, who underwent awake craniotomy for brain tumor surgery from 03/2012–10/2017, were reviewed. Records were analyzed regarding airway management, medication, intraoperative complications and multiple procedural durations. Propofol and fentanyl were used for induction, propofol and remifentanil for maintenance of anesthesia in all patients.

Results: 101 Patients (n=70 (69%), male), were aged 44 (IQR: 32/54) years. Median bodyweight was 80 (IQR 73/88) kg. 17 patients additionally received dexmedetomidine (DEX) (0.7 (IQR: 0.7/1.0) µg/kg/h), resulting in a significantly shorter period of propofol administration (212min.±63 vs. 169min.±47; p=0.008). Patients receiving DEX received a significantly higher cumulative dose of remifentanil (3339µg (IQR: 2277/5213) vs. 5460µg (IQR: 3095/6444); p=0.023)). Airways were controlled with a laryngeal mask in 75 (81%) patients, with endotracheal tube in 17 (18%) patients and with a laryngeal tube in 1 (1%) patient. In 2 of 101 (2%) patients extubation failed due to an inadequate awakening. Re-intubation was necessary for 3 (3%) patients due to refractory intraoperative seizure and in 3 (3%) patients due to respiratory exhaustion. No re-intubation was requested by any patient. Intraoperative seizures occurred in 12 patients (12%). Median awake time was 210 (IQR: 165/263) minutes, 72% of the overall duration of surgery. The median duration of arousal was 15 (IQR: 10/20) minutes.

Conclusion: The asleep-awake technique for cerebral tumor surgery is safe and well tolerated by patients, allowing extensive intraoperative mapping and allows evaluation in the immediate postoperative phase.