Chikezie I Eseonu1, Karim ReFaey1, Oscar Garcia1, Amballur John2, Alfredo Quiñones-Hinojosa3, Punita Tripathi4. 1. Department of Neurological Surgery and Oncology Outcomes Laboratory, Johns Hopkins University, Baltimore, Maryland, USA. 2. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA. 3. Department of Neurological Surgery and Oncology Outcomes Laboratory, Johns Hopkins University, Baltimore, Maryland, USA. Electronic address: quinones@mayo.edu. 4. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA. Electronic address: ptripat2@jhmi.edu.
Abstract
BACKGROUND: Commonly used sedation techniques for an awake craniotomy include monitored anesthesia care (MAC), using an unprotected airway, and the asleep-awake-asleep (AAA) technique, using a partially or totally protected airway. We present a comparative analysis of the MAC and AAA techniques, evaluating anesthetic management, perioperative outcomes, and complications in a consecutive series of patients undergoing the removal of an eloquent brain lesion. METHODS: Eighty-one patients underwent awake craniotomy for an intracranial lesion over a 9-year period performed by a single-surgeon and a team of anesthesiologists. Fifty patients were treated using the MAC technique, and 31 were treated using the AAA technique. A retrospective analysis evaluated anesthetic management, intraoperative complications, postoperative outcomes, pain management, and complications. RESULTS: The MAC and AAA groups had similar preoperative patient and tumor characteristics. Mean operative time was shorter in the MAC group (283.5 minutes vs. 313.3 minutes; P = 0.038). Hypertension was the most common intraoperative complication seen (8% in the MAC group vs. 9.7% in the AAA group; P = 0.794). Intraoperative seizure occurred at a rate of 4% in the MAC group and 3.2% in the AAA group (P = 0.858). Awake cases were converted to general anesthesia in no patients in the MAC group and in 1 patient (3.2%) in the AAA group (P = 0.201). No cases were aborted in either group. The mean hospital length of stay was 3.98 days in the MAC group and 3.84 days in the AAA group (P = 0.833). CONCLUSIONS: Both the MAC and AAA sedation techniques provide an efficacious and safe method for managing awake craniotomy cases and produce similar perioperative outcomes, with the MAC technique associated with shorter operative time.
BACKGROUND: Commonly used sedation techniques for an awake craniotomy include monitored anesthesia care (MAC), using an unprotected airway, and the asleep-awake-asleep (AAA) technique, using a partially or totally protected airway. We present a comparative analysis of the MAC and AAA techniques, evaluating anesthetic management, perioperative outcomes, and complications in a consecutive series of patients undergoing the removal of an eloquent brain lesion. METHODS: Eighty-one patients underwent awake craniotomy for an intracranial lesion over a 9-year period performed by a single-surgeon and a team of anesthesiologists. Fifty patients were treated using the MAC technique, and 31 were treated using the AAA technique. A retrospective analysis evaluated anesthetic management, intraoperative complications, postoperative outcomes, pain management, and complications. RESULTS: The MAC and AAA groups had similar preoperative patient and tumor characteristics. Mean operative time was shorter in the MAC group (283.5 minutes vs. 313.3 minutes; P = 0.038). Hypertension was the most common intraoperative complication seen (8% in the MAC group vs. 9.7% in the AAA group; P = 0.794). Intraoperative seizure occurred at a rate of 4% in the MAC group and 3.2% in the AAA group (P = 0.858). Awake cases were converted to general anesthesia in no patients in the MAC group and in 1 patient (3.2%) in the AAA group (P = 0.201). No cases were aborted in either group. The mean hospital length of stay was 3.98 days in the MAC group and 3.84 days in the AAA group (P = 0.833). CONCLUSIONS: Both the MAC and AAA sedation techniques provide an efficacious and safe method for managing awake craniotomy cases and produce similar perioperative outcomes, with the MAC technique associated with shorter operative time.
Authors: Karim ReFaey; Shashwat Tripathi; Adip G Bhargav; Sanjeet S Grewal; Erik H Middlebrooks; David S Sabsevitz; Mark Jentoft; Peter Brunner; Adela Wu; William O Tatum; Anthony Ritaccio; Kaisorn L Chaichana; Alfredo Quinones-Hinojosa Journal: J Neurooncol Date: 2020-06-10 Impact factor: 4.130
Authors: Anteneh M Feyissa; Gregory A Worrell; William O Tatum; Deependra Mahato; Benjamin H Brinkmann; Steven S Rosenfeld; Karim ReFaey; Perry S Bechtle; Alfredo Quinones-Hinojosa Journal: Neurology Date: 2018-02-28 Impact factor: 9.910
Authors: Ricardo A Domingo; Tito Vivas-Buitrago; Gaetano De Biase; Erik H Middlebrooks; Perry S Bechtle; David S Sabsevitz; Alfredo Quiñones-Hinojosa; William O Tatum Journal: Oper Neurosurg (Hagerstown) Date: 2021-07-15 Impact factor: 2.703
Authors: Borys M Kwinta; Aneta M Myszka; Monika M Bigaj; Roger M Krzyżewski; Anna Starowicz-Filip Journal: Neurol Sci Date: 2020-08-17 Impact factor: 3.307