Intraoperative awake anesthesia applied for tumor excision in cerebral functional areas

ObjectiveTo observe the feasibility and safety of awake anesthesia for tumor excisions in patients with brain tumors involving cerebral functional areas.MethodsFifty patients with brain tumors involving cerebral functional areas, ASA I - II grade, were enrolled in this study. Propofol and remifentanil were used for total intravenous anesthesia, and a laryngeal mask airway (LMA) was inserted for the airway opening and synchronized intermittent mandatory ventilation (SIMV). At the surgeon's request for an intraoperative wake-up test, the propofol infusion was stopped advance of 10–15 min, the remifentanil infusion rate was decreased to 0.050–0.075 μg/kg from 0.10–0.20 μg/kg per min for easing surgical pain. The LMA was removed until the patient awakened. The anesthesiologist then kept up an on-going neurological examination. After that, anesthesia was re-deepened and LMA was re-inserted until the whole surgery was accomplished.ResultsForty-six of 50 patients (92%) were successfully awakened and 4 (8%) failed to complete the intraoperative wake-up test because of dyspnea, over-sedation, or severe hypertension. No severe complications occurred during the whole process. Conclusions: During the awake anesthetic period, the intraoperative wake-up test combined with navigation, evoked potential and ultrasound techniques can help surgeons excise maximumly and precisely the brain tumors near to or in the functional areas.