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Awake craniotomy

Bonhomme, Vincenta; Franssen, Colletteb; Hans, Pola

European Journal of Anaesthesiology (EJA): November 2009 - Volume 26 - Issue 11 - p 906–912
doi: 10.1097/EJA.0b013e32833000c5
Review Articles

Awake craniotomy has become an increasingly frequent procedure. In this paper, the principles of its anaesthetic management are reviewed. The means allowing achievement of anaesthetic objectives are described, with emphasis on points that determine success of the procedure. A careful and adequate selection and preparation of patients are mandatory, and the intervening team must be a skilled team. Choosing an awake technique or general anaesthesia depends on several factors, including the risk of obstructive apnoea, seizures, nausea and vomiting, patient's ability to cooperate, and localization of lesions. The main challenge of intraoperative anaesthetic management relies on the ability of rapidly adjusting the level of sedation and analgesia according to the sequence of surgical events, while ensuring haemodynamic stability, adequate ventilation, and minimal interference with eventual eletrophysiological recordings. Throughout the procedure, complications must be anticipated and managed according to predefined guidelines. More prospective randomized clinical trials are still needed to improve safety and efficacy of awake craniotomies, as well as to validate this technique in comparison with more conventional anaesthetic management.

aUniversity Department of Anaesthesia and Intensive Care Medicine, CHR de la Citadelle, Belgium

bDepartment of Anaesthesia and Intensive Care Medicine, CHU de Liege, Liege, Belgium

Received 22 June, 2009

Accepted 23 June, 2009

Correspondence to Vincent Bonhomme, MD, PhD, University Department of Anaesthesia and Intensive Care Medicine, CHR de la Citadelle, Bd du 12eme de Ligne 1, 4000 Liege, Belgium Tel: +32 4 225 7117; fax: +32 4 225 7308; e-mail:

© 2009 European Society of Anaesthesiology