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Anales de la Facultad de Ciencias Médicas (Asunción)
Print version ISSN 1816-8949
Abstract
DELGADO MAIDANA, Walter; PERALTA, Amado David; URBIETA, Ulises and VEGA CARDUZ, Evanhy. Anesthesia during awake craniotomy. Report of the first cases in Paraguay. An. Fac. Cienc. Méd. (Asunción) [online]. 2022, vol.55, n.3, pp.126-132. ISSN 1816-8949. https://doi.org/10.18004/anales/2022.055.03.126.
Craniotomies in conscious patients (CCP) pose challenges for anesthesiologists, such as the need to keep the patient sedated, conscious, calm, comfortable, neurologically sound and cooperative, without respiratory or hemodynamic compromise and provided with excellent analgesia, while allowing their cooperation during neurological tests. The series of 6 first cases in our environment is presented, through which the objective is to describe the anesthetic management of craniotomies in conscious patients. An observational, descriptive and cross-sectional study was carried out, retrospective time frame in patients undergoing CCP at the Hospital de Clínicas. The anesthetic management discriminated by phases was as follows. Phase 1 (asleep: 6 patients): Induction with Propofol, Lidocaine, Atracurium and Remifentanil. Placement of laryngeal masks. Scalp regional lock. Remifentanil maintenance. Phase 2 with conscious sedation (awake: 6 patients): removal of the laryngeal mask and infusion of low-dose propofol and remifentanil to maintain Ramsay 2. Phase 3 (awake: 4 patients): the dose of propofol and remifentanil was increased to obtain a Ramsay 3. Phase 3 (asleep: 2 patients): anesthetic induction was performed with the same doses as phase 1 and orotracheal intubation. Maintenance with propofol and remifentanil. In conclusion, anesthesia allowed rapid and adequate intraoperative awakening for the conscious phase, the administration of low doses of remifentanil and propofol during this second phase provided the patient with a good state of comfort for collaboration with cognitive and motor tests.
Keywords : anesthesia; craniotomy; conscious sedation..
