WikiAnesthesia - User contributions [en]

Awake craniotomy

2021-05-10T13:00:24Z

Kiran.Guthikonda: populated fields in Preoperative and Preparation section

{{Infobox surgical case reference
| anesthesia_type =
| airway =
| lines_access =
| monitors =
| considerations_preoperative =
| considerations_intraoperative =
| considerations_postoperative =
}}

Awake craniotomy is a surgical technique that is sometimes employed for patients undergoing tumor excision or clipping of arteriovenous malformation in regions of the brain that involve speech or motor function. Due to the "unconventional" nature of the surgery, this technique is generally reserved for patients who have undergone careful preoperative selection, with considerations for temperament, overall health status, and adequate education.

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Neurologic
|
* As with all neurosurgical techniques, a careful preoperative neurological history and exam should be conducted and documented preoperatively to obtain a baseline assessment of function preoperatively. This exam should be particularly focused on eliciting deficits that may exist due to the nature of the lesion that is to be intervened on.
* Patients may exhibit signs and symptoms of increased ICP, neurological deficits from impingement of motor areas, or intracranial bleeding.<ref>{{Cite journal|last=Buckner|first=JC|date=2007|title=Central nervous system tumors|url=|journal=Mayo Clin Proc|volume=82(10)|pages=1271-86|via=}}</ref>
|-
|Cardiovascular
|
* Assess for cardiovascular comorbidities prior to the day of surgery
* Acute intraoperative stress response associated with the procedure (i.e. being under drapes, head clamped in Mayfield pins, listening to the sound of the surgeons working, etc.) may in some instances result in cardiovascular dysfunction.
* Increased ICP may result in "Cushing triad" of HTN, bradycardia, and irregular respiratory pattern.<ref name=":0">{{Cite book|last=Jaffe|first=Richard A.|title=Anesthesiologist's Manual of Surgical Procedures|publisher=Wolters Kluwer|year=2014|isbn=978-1-4511-7660-5|location=New York|pages=31-36}}</ref>
* The patient should have demonstrated no significant issues managing situations requiring exertion and psychological responses (e.g. panic episodes) that might result in tachyarrhythmias.
|-
|Respiratory
|
* Any significant respiratory comorbidity (e.g. advanced COPD requiring supplemental oxygen or history of exacerbation, asthma with history of exacerbations requiring rescue inhaler use, etc.) should elicit a preoperative assessment with an physician preoperatively prior to the day of surgery for determination of suitability for this procedure.
|-
|Gastrointestinal
|
* History of nausea and/or vomiting, especially on the day of surgery, should result in a careful reassessment in terms of proceeding to surgery immediately due to risk of intraoperative aspiration.
* History of significant uncontrolled gastrointestinal reflux (GERD), may be a contraindication for this procedure due to periods of the procedure that require the lack of protected airway. If patient is in Mayfield pins, active GERD may trigger cough, resulting in potential for injury to head and neck.
|-
|Hematologic
|
* Any issues with normal coagulation should be assessed to determine if significant blood loss will result, and anesthetic technique adjusted accordingly, including invasive monitoring, preoperative type and screen, and adequate IV access.
|-
|Renal
|
* The patient should be informed that a Foley catheter will be placed at the beginning of the procedure under sedation, and that they will have the sensation of the catheter in their lower urinary tract when awakened during the procedure.
|-
|Endocrine
|
* In patients with a history of diabetes mellitus, intraoperative glucose monitoring should be routinely conducted to prevent complications. For an awake technique in particular, hypoglycemia and extreme hyperglycemia may result in altered mental status that could result in issues with inappropriate neurological monitoring during tumor excision, disinhibition, and airway compromise.
* Patients with a history of other endocrine disorders should also be counseled on possible complications associated with their particular disease process as it relates to anesthesia.
|}

=== Labs and studies ===

* Verify normal coagulation studies
* Obtain CBC, and electrolyte panel prior to surgery

=== Operating room setup ===

* Be aware of type of table and head support to be employed to adjust anesthesia technique accordingly.

=== Patient preparation and premedication ===

* The patient should counseled extensively on the process of awake craniotomy in great detail to avoid surprises that may result in untoward anxiety intraoperatively.
* premedication with a short-acting benzodiazepines such as midazolam (in an incremental titrated dose administration to 1-10 mg IV)<ref name=":0" />
* dexmedetomidine (0.2-0.7 mcg/kg/hr) may be helpful for preoperative line placement<ref name=":0" />

=== Regional and neuraxial techniques ===

* scalp blocks are placed using 0.5% bupivacaine with epinephrine: [https://www.youtube.com/watch?v=5mTEa7ZdM_g Scalp blocks (by user: Regional Anesthesiology and Pain Medicine @youtube.com)]<ref>{{Citation|title=Scalp Blocks|url=https://www.youtube.com/watch?v=5mTEa7ZdM_g|language=en|access-date=2021-05-10}}</ref>

== Intraoperative management ==

=== Monitoring and access ===

=== Induction and airway management ===

=== Positioning ===

=== Maintenance and surgical considerations ===

=== Emergence ===

== Postoperative management ==

=== Disposition ===

=== Pain management ===

=== Potential complications ===

== Procedure variants ==

{| class="wikitable"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}

== References ==
<references />
[[Category:Surgical procedures]]

Awake craniotomy

2021-04-30T15:43:16Z

Kiran.Guthikonda: populated summary and preoperative assessment table

{{Infobox surgical case reference
| anesthesia_type =
| airway =
| lines_access =
| monitors =
| considerations_preoperative =
| considerations_intraoperative =
| considerations_postoperative =
}}

Awake craniotomy is a surgical technique that is sometimes employed for patients undergoing tumor excision or clipping of arteriovenous malformation in regions of the brain that involve speech or motor function. Due to the "unconventional" nature of the surgery, his technique is generally reserved for patients who have undergone careful preoperative selection, with considerations for temperament, overall health status, and adequate education.

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Neurologic
|
* As with all neurosurgical techniques, a careful preoperative neurological history and exam should be conducted and documented preoperatively to obtain a baseline assessment of function preoperatively. This exam should be particularly focused on eliciting deficits that may exist due to the nature of the lesion that is to be intervened on.
* Patients may exhibit signs and symptoms of increased ICP, neurological deficits from impingement of motor areas, or intracranial bleeding.
|-
|Cardiovascular
|
* Assessed for cardiovascular comorbidities prior to the day of surgery
* Acute intraoperative stress response associated with the procedure (i.e. being under drapes, head clamped in Mayfield pins, listening to the sound of the surgeons working, etc.) may in some instances result in cardiovascular dysfunction.
* The patient should have demonstrated no significant issues managing situations requiring exertion and psychological responses (e.g. panic episodes) that might result in tachyarrhythmias
|-
|Respiratory
|
* Any significant respiratory comorbidity (e.g. advanced COPD requiring supplemental oxygen or history of exacerbation, asthma with history of exacerbations requiring rescue inhaler use, etc.) should elicit a preoperative assessment with an physician preoperatively prior to the day of surgery for determination of suitability for this procedure.
|-
|Gastrointestinal
|
* History of nausea and/or vomiting, especially on the day of surgery, should result in a careful reassessment in terms of proceeding to surgery immediately.
* History of significant uncontrolled gastrointestinal reflux (GERD), may be a contraindication for this procedure due to periods of the procedure that require extubation if general anesthesia for the beginning of the procedure is selected as anesthetic technique.
|-
|Hematologic
|
* Any issues with normal coagulation should be assessed to determine if significant blood loss will result, and anesthetic technique including invasive monitoring, preoperative type and screen, and adequate IV access should be obtained prior to start of the procedure.
|-
|Renal
|
* The patient should be informed that a Foley catheter will be placed at the beginning of the procedure under sedation, and that they will have the sensation of the catheter in their lower urinary tract when awakened during the procedure.
|-
|Endocrine
|
* In patients with a history of hypoglycemia and hyperglycemia in particular, intraoperative glucose monitoring should be routinely conducted to prevent complications.
* Patients with a history of other endocrine disorders should also be counseled on possible complications associated with the particular disease process as it relates to anesthesia.
|-
|Other
|
|}

=== Labs and studies ===

=== Operating room setup ===

=== Patient preparation and premedication ===

=== Regional and neuraxial techniques ===

== Intraoperative management ==

=== Monitoring and access ===

=== Induction and airway management ===

=== Positioning ===

=== Maintenance and surgical considerations ===

=== Emergence ===

== Postoperative management ==

=== Disposition ===

=== Pain management ===

=== Potential complications ===

== Procedure variants ==

{| class="wikitable"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}

== References ==

[[Category:Surgical procedures]]

Percutaneous transluminal coronary angioplasty

2021-03-16T20:02:50Z

Kiran.Guthikonda: added template

{{Infobox surgical case reference
| anesthesia_type =
| airway =
| lines_access =
| monitors =
| considerations_preoperative =
| considerations_intraoperative =
| considerations_postoperative =
}}

Provide a brief summary of this surgical procedure and its indications here.

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Neurologic
|
|-
|Cardiovascular
|
|-
|Respiratory
|
|-
|Gastrointestinal
|
|-
|Hematologic
|
|-
|Renal
|
|-
|Endocrine
|
|-
|Other
|
|}

=== Labs and studies ===

=== Operating room setup ===

=== Patient preparation and premedication ===

=== Regional and neuraxial techniques ===

== Intraoperative management ==

=== Monitoring and access ===

=== Induction and airway management ===

=== Positioning ===

=== Maintenance and surgical considerations ===

=== Emergence ===

== Postoperative management ==

=== Disposition ===

=== Pain management ===

=== Potential complications ===

== Procedure variants ==

{| class="wikitable"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}

== References ==

[[Category:Surgical procedures]]