Awake craniotomy in a patient with ejection fraction of 10%: considerations of cerebrovascular and cardiovascular physiology

• An unique case: A 37-year-old man with nonischemic 4-chamber dilated cardiomyopathy and low-output cardiac failure (estimated ejection fraction of 10%), a candidate for cardiac transplantation, underwent awake craniotomy for a low-grade oligodendroglioma resection under monitored anesthesia care.
• Educational: The unique challenges and key points of management pertinent to cerebrovascular and cardiovascular physiology are discussed.
• The relationship between cardiac output and cerebral blood flow is discussed.
• The management of systemic hemodynamics including arterial blood pressure and cardiac output is discussed.
• The rationale behind the management of red blood cell transfusion is presented.
• All clincial decision-making processes are presented.

A 37-year-old man with nonischemic 4-chamber dilated cardiomyopathy and low-output cardiac failure (estimated ejection fraction of 10%) underwent awake craniotomy for a low-grade oligodendroglioma resection under monitored anesthesia care. The cerebrovascular and cardiovascular physiologic challenges and our management of this patient are discussed.