Evaluation Of Analgesia And Dynamic Parameters During Infusion Of Dexmedetomidine And Remifentanil In Awake CraniotomyName : Dr. Floriana Melicchio
Affliation : Professor
University : University Hospital Polyclinic Vittorio Emanuele
Country : Catania, Sicily
Background: Awake Craniotomy (AC) is an accepted procedure for brain tumours resection, used to achieve maximal surgical reduction while sparing important functional areas, such as motor, language, or sensory cortex.
During AC anesthesia should not only provide an adequate sedation, analgesia and respiratory/hemodynamic stability but also keep the patient awake, comfortable and cooperative for proper neurological testing.
Materials & Methods: We report our experience with two similar cases, respectively a 42 years old man presenting with a 36 mm insular lesion (P1)and a 50 years old woman presenting with a 65 mm fronto-insular lesion(P2)for which neurosurgeon planned an awake craniotomy.
We chose to manage anesthesia with a Dexmedetomidine (0.2-0.4g/kg/h [P1], 0.16-0.26g/kg/h [P2]) and Remifentanil (0.02-0.04g/kg/min)continuous infusion plus a 30 mL local infiltration of 1%Lidocaine with Adrenaline (5g/ml)in the Mayfield headpins followed by 20 mL scalp block(P1:0.2%Ropivacaine with Adrenaline5g/ml; P2:1%Lidocaine, 0.75%Levobupivacaine with Adrenaline 5 g/ml).
Results: Patients interacted with the team for the entire course of the procedure. Sedation level was assessed with MOAA/S scale and RASS. Patient cooperation stayed high, except in the second case by the end of surgery when she responded only after mild prodding. Pain level was measured using VAS and ANI monitor in order to obtain very low level or no pain. Clear sight System records no cardiac instability. Neurosurgeons performed cortical stimulation and both neuropsychological and cognitive tests with any problems.
Conclusions: The sedation with low levels of DEX-Remifentanil infusions allowed an adequate patient cooperation, sedation and pain management. We propose DEX-TCI infusion in order to perform a better drug titration, avoiding over sedation.