Anaesthetic Management of Left Temporal Glioma Undergoing Awake Craniotomy
Roshan Nisal
Department of Anaesthesiology , Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science, India.
Vasam Rajesh Kumar *
Department of Anaesthesiology , Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science, India.
Wankhade Prachi Pandit
Department of Anaesthesiology , Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science, India.
Sanjot Ninave
Department of Anaesthesiology , Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science, India.
*Author to whom correspondence should be addressed.
Abstract
For an awake craniotomy, a 49 year old (ASA 2), 78 kg woman with type II DM was given regional anaesthesia (scalp block) with monitored anaesthesia care (MAC). She had a headache, which was primarily caused by a left temporal glioma. She was very apprehensive about having this procedure done while she was awake. Fentanyl and Dexmedetomidine infusions in combination with scalp block initially provided adequate operating conditions. Because the patient needed to be fully awake, alert and cooperative during the language and motor mapping, all sedation was turned off. Patient was cooperative and obeyed commands during motor and language mapping as well as during tumour excision. Patient underwent complete excision of tumour without any postoperative neurological deficit. The success of the awake craniotomy is dependent on the patient cooperation, anaesthesiologist's experience, adequate intraoperative analgesia coverage, careful sedation titration, and meticulous planning.
Keywords: Awake craniotomy, conscious sedation, dexmedetomidine, scalp block