Jeremy Arzoine1, Charlotte Levé1,2, Antonio Pérez-Hick3, John Goodden4, Fabien Almairac5, Sylvie Aubrun1, Etienne Gayat1,6, Christian F Freyschlag7, Fabrice Vallée1,2, Emmanuel Mandonnet8,9,10, Catherine Madadaki1. 1. Department of Anesthesiology and Critical Care, St-Louis-Lariboisière-Fernand Widal University Hospitals, APHP, Paris, France. 2. INSERM UMR-942, Paris, France. 3. Department of Anesthesiology, Hospital Garcia de Orta, Almada, Portugal. 4. Department of Neurosurgery, Leeds General Infirmary, Leeds, UK. 5. Department of Neurosurgery, Hôpital Pasteur II, University Hospital of Nice, Nice, France. 6. University Paris 7, Paris, France. 7. Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria. 8. University Paris 7, Paris, France. mandonnet@mac.com. 9. Department of Neurosurgery, Lariboisière Hospital, APHP, Paris, France. mandonnet@mac.com. 10. Frontlab, Institut du Cerveau et de la Moelle épinière, Inserm U 1127, CNRS UMR 7225, Paris, France. mandonnet@mac.com.
Abstract
BACKGROUND: Awake surgery has become a key treatment of diffuse low-grade gliomas (DLGG) and is divided in three main phases: opening, tumor resection - during which the patient needs to be fully awake - and closure. The anesthetic management of awake neurosurgery is a challenge, and there are currently no guidelines. OBJECTIVE: The objective of the survey was to explore differences and commonalities regarding the anesthetic management of awake DLGG surgery within the European Low-Grade Glioma Network (ELGGN) centers. METHODS: A form that contained 14 questions about the anesthetic management was sent to 28 centers in May 2015. RESULTS: Twenty centers responded. During the opening and closing non-awake periods, 56% of teams chose general anesthesia with mechanical ventilation for at least one period (asleep-awake-asleep, SAS protocol), and 44% monitored anesthesia care including sedation without mechanical ventilation (MAC protocol). In case of SAS, all the teams chose intravenous anesthesia, 82% used laryngeal mask instead of endotracheal intubation during the opening sequence, and 71% during closure. Local and regional anesthesia was practiced by all the teams. The most frequently reported cause of pain was dural and cerebral vessels manipulation (77%). Pain management was mostly based on paracetamol (70%) and remifentanil (55%). CONCLUSION: Our survey showed that there was an equivalent proportion of centers using SAS or MAC protocols in the anesthetic management of awake surgery in ELGGN centers. The advantages and disadvantages of each anesthesia protocol were reviewed.
BACKGROUND: Awake surgery has become a key treatment of diffuse low-grade gliomas (DLGG) and is divided in three main phases: opening, tumor resection - during which the patient needs to be fully awake - and closure. The anesthetic management of awake neurosurgery is a challenge, and there are currently no guidelines. OBJECTIVE: The objective of the survey was to explore differences and commonalities regarding the anesthetic management of awake DLGG surgery within the European Low-Grade Glioma Network (ELGGN) centers. METHODS: A form that contained 14 questions about the anesthetic management was sent to 28 centers in May 2015. RESULTS: Twenty centers responded. During the opening and closing non-awake periods, 56% of teams chose general anesthesia with mechanical ventilation for at least one period (asleep-awake-asleep, SAS protocol), and 44% monitored anesthesia care including sedation without mechanical ventilation (MAC protocol). In case of SAS, all the teams chose intravenous anesthesia, 82% used laryngeal mask instead of endotracheal intubation during the opening sequence, and 71% during closure. Local and regional anesthesia was practiced by all the teams. The most frequently reported cause of pain was dural and cerebral vessels manipulation (77%). Pain management was mostly based on paracetamol (70%) and remifentanil (55%). CONCLUSION: Our survey showed that there was an equivalent proportion of centers using SAS or MAC protocols in the anesthetic management of awake surgery in ELGGN centers. The advantages and disadvantages of each anesthesia protocol were reviewed.
Entities:
Keywords:
Anesthesia management; Awake surgery; European survey; Low-grade glioma; Neuroanesthesia
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