Some aspects of awake craniotomy, including indications and contraindications, benefits, anesthetic techniques, challenges, and potential future directions are discussed. The improvements in anesthetic agents and techniques, especially shorter and more dependable durations of actions, have also made a great contribution. During the last several decades, this procedure has become increasingly popular with wider indications prompted by accumulating evidence that patients receiving awake craniotomy have better outcomes in many aspects. It has a long history that pre-dates general anesthesia (GA) as there are many examples of paintings and descriptions of such procedures, especially trephination, dating back over a thousand years. Esta revisión hace referencia a las indicaciones y contraindicaciones, beneficios, técnicas de anestesia, desafíos y manejo, así como a posibles orientaciones a futuro de la craneotomía con el paciente despierto.Īwake craniotomy can be defined as an intracranial surgical procedure where the patient is deliberately awake for a portion of the surgery, usually for mapping and resection of the lesion. Este abordaje al procedimiento quirurgico intracraneal requiere pericia, experiencia y compromiso por parte de todo el equipo de la sala de cirugía. En todas las técnicas de sedación - anestesia, los pacientes se encuentran despiertos y con capacidad para hablar y/o moverse durante la fase de mapeo. Los esquemas anestésicos comunes van desde la sedación leve a moderada, sedación profunda, o anestesia general durante las fases pre y post-mapeo. Los medicamentos de uso frecuente son propofol, dexmedetomidina y remifentanilo. Los avances en los agentes y las técnicas de anestesia, particularmente la mascarilla laríngea, han hecho grandes aportes. El abordaje con el paciente despierto ha adquirido cada vez más popularidad y se han ampliado sus indicaciones gracias a la ventaja de mejores desenlaces neurológicos y perioperatorios, entre ellos la analgesia y la náusea y vómito postoperatorios.

Se trata por lo general de las areas del habla y motoras. La craneotomía con el paciente despierto se utiliza fundamentalmente para el mapeo y la resección de lesiones en áreas de vital importancia en el cerebro, en donde las imágenes no son suficientemente sensibles. This review, from the point of view of authors, discusses the indications and contraindications, benefits, anesthetic techniques, challenges, and management, as well as potential future directions of awake craniotomy. This approach to intracranial surgical procedures requires skill, experience, and commitment on the part of the entire OR team. In all sedation-anesthesia techniques, the patients are awake and able to speak and/or move during the mapping phase. Common anesthetic regimens range from light-moderate sedation, deep sedation, or general anesthesia during the pre-mapping and postmapping phases. Frequently used medications are propofol, dexmedetomidine, and remifentanil. Improvements in anesthetic agents and techniques especially laryngeal mask airway have made a great contribution. The awake approach has become increasingly popular with wider indications due to the advantage of better neurological and other perioperative outcomes including analgesia and postoperative nausea and vomiting. These are most commonly speech and motor areas. Awake craniotomy is mainly used for mapping and resection of lesions in vitally important brain areas where imaging is not sufficiently sensitive.

Eloquent brain areas