Severe remifentanil-induced acute opioid tolerance following awake craniotomy in an adolescent.

Anesthetic goals for procedures involving resections close to the motor cortex include immobility, analgesia, and a level of consciousness that allows for the ability to follow motor commands. Remifentanil as a single agent is an attractive choice, particularly when ventilation is controlled. The successful use of large-dose remifentanil infusion during an awake craniotomy in a 16 year-old man and the subsequent severe acute opioid tolerance is presented.