Preliminary evaluation of ketofol-based sedation for awake craniotomy procedures

BackgroundThe study aimed at evaluating the clinical efficiency of a ketofol-based sedation procedure during awake craniotomy for varied surgical indications.MethodsThe study included 28 patients; 19 males and 9 females with mean age of 33.4 ± 9.3 years. All patients received propofol (0.5 mg/kg/h) and ketamine (0.5 mg/kg/h) infusion mixture in 1:1 ratio. Conscious level was evaluated using the Modified Observer's Assessment of Alertness/Sedation scale and patients were maintained at level 3, at which the patients will respond after their name is called loudly or repeatedly; otherwise patient was considered over-sedated. Intraoperative (IO) monitoring included intracranial pressure (ICP), hemodynamic and respiratory changes, brain status, whether slack or tense, the frequency of over-sedations and adverse events. Duration of surgery, time till PACU transfer, total anesthesia time, postoperative (PO) complications and duration of hospital stay were reported. Patients’ satisfaction, on 0–10 score, about the procedure used for awake sedation was inquired.ResultsMean duration of surgery was 168.8 ± 19.4 min; mean time till PACU transfer after stoppage of infusion was 11.1 ± 1.7 min for a mean anesthesia time of 179.9 ± 19.2 min. Three patients had blood pressure changes, 4 had heart rate variability, 2 had respiratory depression and one had SpO2 <90%. Two patients developed focal seizures, one had nausea and 2 patients were over-sedated. Brain was tense in only 3 patients (10.7%). Four patients had PO transient neurological deficits, 3 patients had PO seizures and only 2 patients had recurrent attacks of nausea and vomiting; however, these complications responded to treatment. Mean hospital stay was 3.1 ± 1.1 days. Mean satisfaction score was 9.1 ± 1.2; range: 6–10 with a satisfaction rate of 78.6%.ConclusionConscious sedation during awake craniotomy using ketofol infusion mixture in 1:1 ratio was safe and efficient with minor hemodynamic and respiratory events and rapid smooth recovery profile.