<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1816-8949</journal-id>
<journal-title><![CDATA[Anales de la Facultad de Ciencias Médicas (Asunción)]]></journal-title>
<abbrev-journal-title><![CDATA[An. Fac. Cienc. Méd. (Asunción)]]></abbrev-journal-title>
<issn>1816-8949</issn>
<publisher>
<publisher-name><![CDATA[EFACIM. Editorial de la Facultad de Ciencias Médicas - Universidad Nacional de Asunción]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1816-89492022000300126</article-id>
<article-id pub-id-type="doi">10.18004/anales/2022.055.03.126</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Anestesia en craneotomías con el paciente despierto. Reporte de los primeros casos en Paraguay]]></article-title>
<article-title xml:lang="en"><![CDATA[Anesthesia during awake craniotomy. Report of the first cases in Paraguay]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Delgado Maidana]]></surname>
<given-names><![CDATA[Walter]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Peralta]]></surname>
<given-names><![CDATA[Amado David]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Urbieta]]></surname>
<given-names><![CDATA[Ulises]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Vega Carduz]]></surname>
<given-names><![CDATA[Evanhy]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad Nacional de Asunción Facultad de Ciencias Médicas Hospital de Clínicas, Cátedra de Anestesiología]]></institution>
<addr-line><![CDATA[San Lorenzo ]]></addr-line>
<country>Paraguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2022</year>
</pub-date>
<volume>55</volume>
<numero>3</numero>
<fpage>126</fpage>
<lpage>132</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_arttext&amp;pid=S1816-89492022000300126&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_abstract&amp;pid=S1816-89492022000300126&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_pdf&amp;pid=S1816-89492022000300126&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN Las craneotomías en pacientes conscientes (CPC) plantea desafíos para los anestesiólogos, como la necesidad de mantener al paciente sedado, consciente, tranquilo, cómodo, neurológicamente íntegro y colaborador, sin compromiso respiratorio o hemodinámico y provisto de una excelente analgesia, al tiempo de permitir su cooperación durante las pruebas neurológicas. Se presenta la serie de 6 primeros casos en nuestro medio, a través de los cuales se tiene por objetivo describir el manejo anestésico de craneotomías en pacientes conscientes. Se realizó un estudio observacional, descriptivo y de corte transverso, marco temporal retrospectivo en pacientes sometidos a CPC en el Hospital de Clínicas. El manejo anestésico discriminado por fases fue de la siguiente manera. Fase 1 (dormido: 6 pacientes): Inducción con Propofol, Lidocaína, Atracurio y Remifentanilo. Colocación de máscaras laríngeas. Bloqueo regional de escalpe. Mantenimiento con Remifentanilo. Fase 2 con sedación consciente (despierto: 6 pacientes): retiro de máscara laríngea y perfusión de dosis baja de propofol y remifentanilo para mantener un Ramsay 2. Fase 3 (despierto: 4 pacientes): se aumentó la dosis de propofol y remifentanilo para obtener un Ramsay 3. Fase 3 (dormido: 2 pacientes): se realizó inducción anestésica con mismas dosis de la fase 1 e intubación orotraqueal. Mantenimiento con propofol y remifentanilo. En conclusión, la anestesia permitió un despertar intraoperatorio rápido y adecuado para la fase consciente, la administración de dosis bajas de remifentanilo y propofol durante esta segunda fase proporcionaron a los pacientes un buen estado de confort para su colaboración con los test cognitivos y motores.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT 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.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[anestesia]]></kwd>
<kwd lng="es"><![CDATA[craneotomía]]></kwd>
<kwd lng="es"><![CDATA[sedación consciente.]]></kwd>
<kwd lng="en"><![CDATA[anesthesia]]></kwd>
<kwd lng="en"><![CDATA[craniotomy]]></kwd>
<kwd lng="en"><![CDATA[conscious sedation.]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Benatar-Haserfaty]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Tardáguila Sancho]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Anestesia para la craneotomía en el paciente consciente]]></article-title>
<source><![CDATA[Revista Española de Anestesiología y Reanimación]]></source>
<year>2013</year>
<volume>60</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>264-74</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Madriz-Godoy]]></surname>
<given-names><![CDATA[MM]]></given-names>
</name>
<name>
<surname><![CDATA[Trejo-Gallegos]]></surname>
<given-names><![CDATA[SA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Anaesthetic technique during awake craniotomy. Case report and literature review]]></article-title>
<source><![CDATA[Revista Médica del Hospital General de México]]></source>
<year>2016</year>
<volume>79</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>155-60</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Jaramillo-Magaña]]></surname>
<given-names><![CDATA[JJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Anestesia para craneotomía con el paciente despierto]]></article-title>
<source><![CDATA[Anestesia en Neurocirugía]]></source>
<year>2009</year>
<volume>32</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>77-8</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ramírez-Segura]]></surname>
<given-names><![CDATA[EH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Anestesia para craneotomía con el paciente despierto: Técnica dormido-despierto-dormido]]></article-title>
<source><![CDATA[Revista Mexicana Anestesiología]]></source>
<year>2014</year>
<volume>37</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>42-6</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Zhang]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Gelb]]></surname>
<given-names><![CDATA[AW]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Craneotomía en el paciente despierto: Indicaciones, beneficios y técnicas. Reporte de caso]]></article-title>
<source><![CDATA[Revista Colombiana de Anestesiología]]></source>
<year>2018</year>
<volume>46</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>49-55</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Orozco-Ramírez]]></surname>
<given-names><![CDATA[SM]]></given-names>
</name>
<name>
<surname><![CDATA[Hernández-Sánchez]]></surname>
<given-names><![CDATA[BM]]></given-names>
</name>
<name>
<surname><![CDATA[Miranda-González]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Alba-Salmerón]]></surname>
<given-names><![CDATA[AL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Técnica dormido-despierto, tumor en área funcional]]></article-title>
<source><![CDATA[Revista Mexicana Anestesiología]]></source>
<year>2017</year>
<volume>40</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>312-9</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Archer]]></surname>
<given-names><![CDATA[DP]]></given-names>
</name>
<name>
<surname><![CDATA[McKenna]]></surname>
<given-names><![CDATA[JMA]]></given-names>
</name>
<name>
<surname><![CDATA[Ravussin]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Conscious sedation analgesia during craniotomy for intractable epilepsy: a review of 354 consecutive cases]]></article-title>
<source><![CDATA[Revista Canadiense de Anestesia]]></source>
<year>1988</year>
<volume>35</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>338-44</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Deras]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Moulinié]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Maldonado]]></surname>
<given-names><![CDATA[IL]]></given-names>
</name>
<name>
<surname><![CDATA[Moritz-Gasser]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Duffau]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Bertram]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Intermittent general anesthesia with controlled ventilation for asleep-awake-asleep brain surgery: a prospective series of 140 gliomas in eloquent areas]]></article-title>
<source><![CDATA[Neurosurgery]]></source>
<year>2012</year>
<volume>71</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>764-71</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Erickson]]></surname>
<given-names><![CDATA[KM]]></given-names>
</name>
<name>
<surname><![CDATA[Cole]]></surname>
<given-names><![CDATA[DJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Anesthetic considerations for awakecraniotomy for epilepsy and functional neurosurgery]]></article-title>
<source><![CDATA[Anesthesiology Clinic]]></source>
<year>2012</year>
<volume>30</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>241-68</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Klimek]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Verbrugge]]></surname>
<given-names><![CDATA[SJ]]></given-names>
</name>
<name>
<surname><![CDATA[Roubos]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[van der Most]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Vincent]]></surname>
<given-names><![CDATA[AJ]]></given-names>
</name>
<name>
<surname><![CDATA[Klein]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Awake craniotomy for glioblastoma in a 9-year-oldchild]]></article-title>
<source><![CDATA[Anaesthesia]]></source>
<year>2004</year>
<volume>59</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>607-9</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Conte]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[L&#8217;Acqua]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Rotelli]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Bispectral index during asleep-awake craniotomies]]></article-title>
<source><![CDATA[Journal Neurosurgy Anesthesiology]]></source>
<year>2013</year>
<volume>25</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>279-84</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Chui]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Anestesia para craneotomía en el paciente despierto: una actualización]]></article-title>
<source><![CDATA[Revista Colombiana Anestesiología]]></source>
<year>2015</year>
<volume>43</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>22-8</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hervey-Jumper]]></surname>
<given-names><![CDATA[SL]]></given-names>
</name>
<name>
<surname><![CDATA[Li]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Lau]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Molinaro]]></surname>
<given-names><![CDATA[AM]]></given-names>
</name>
<name>
<surname><![CDATA[Perry]]></surname>
<given-names><![CDATA[DW]]></given-names>
</name>
<name>
<surname><![CDATA[Meng]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Berger]]></surname>
<given-names><![CDATA[MS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Awake craniotomy to maximize glioma resection: methods and technical nuances over a 27-year period]]></article-title>
<source><![CDATA[Journal of Neurosurgy]]></source>
<year>2015</year>
<volume>123</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>324-39</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Burnand]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Sebastian]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Anaesthesia for awake craniotomy]]></article-title>
<source><![CDATA[Anaesthesia Critical Care Pain]]></source>
<year>2014</year>
<volume>14</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>6-11</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
