Anesthetic management with propofol/remifentanil target controlled infusion for awake craniotomy: A case report

Kim, Yee Suk; Bae, Hyun Min; Kim, Jong Bun; Kim, Tae Kwane; Ryu, Keon Hee

Case Report

Neuroanesthesia

Anesthesia and Pain Medicine 2012;7(3):245-248.
Published online July 31, 2012.

Anesthetic management with propofol/remifentanil target controlled infusion for awake craniotomy: A case report

Yee Suk Kim, Hyun Min Bae, Jong Bun Kim, Tae Kwane Kim, Keon Hee Ryu

Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Bucheon, Korea. 3tkkim@catholic.ac.kr

Abstract

Awake craniotomy is indicated for tumor resection involving eloquent cortex. It allows the operator to perform appropriate cortical mapping during surgery and facilitate maximum tumor resection while minimizing neurologic deficit. Therefore anesthesia should provide adequate analgesia and sedation but also importantly a full consciousness and cooperation for neurologic testing. This case reports the use of target-controlled infusion (TCI) and monitoring of sedation and anesthetic depth through bispectral index (BIS), providing good control of sedation and analgesia to meet frequent changes throughout the different levels of the procedure while maintaining good condition for intraoperative brain mapping. We propose that TCI of propofol and remifentanil in combination may be a useful alternative for awake craniotomy requiring intraoperative brain mapping surgery.

Key Words: Awake craniotomy, Bispectral index (BIS), Conscious sedation, Target-controlled infusion (TCI)