Awake craniotomy - Revision history

Chris.Rishel at 23:53, 11 July 2024

2024-07-11T23:53:41Z

← Older revision		Revision as of 16:53, 11 July 2024
Line 45:		Line 45:
	**discomfort with position should be addressed early before pt becomes distressed		**discomfort with position should be addressed early before pt becomes distressed
	**presence of aura, indicating impending seizure		**presence of aura, indicating impending seizure
	*Patient will be asked to perform tasks and/or answer questions throughout the procedure		*Patient will be asked to perform tasks and/or answer questions to ensure neurologic intactness throughout the procedure

	=== Patient evaluation ===		=== Patient evaluation ===

Chris.Rishel at 20:22, 19 May 2024

2024-05-19T20:22:41Z

← Older revision		Revision as of 13:22, 19 May 2024
Line 127:		Line 127:
	*Provide sedation using:<ref name=":0" />		*Provide sedation using:<ref name=":0" />
	**Midazolam 1-10 mg IV (titrated incremental doses)		**Midazolam 1-10 mg IV (titrated incremental doses)
	**Dexmedetomidine 0.2-0.7 mcg/kg/hr		**Dexmedetomidine 0.2-0.7 mcg/kg/hr (±1 mcg/kg bolus)
	**Propofol 25-50 mcg/kg/min		**Propofol 25-50 mcg/kg/min
	*Place lines with field blocks using buffered lidocaine for patient comfort		*Place lines with field blocks using buffered lidocaine for patient comfort

Chris.Rishel: Added description and reference for single syringe of lidocaine and bupivacaine with bicarbonate and epinephrine

2024-05-19T20:21:25Z

Added description and reference for single syringe of lidocaine and bupivacaine with bicarbonate and epinephrine

← Older revision		Revision as of 13:21, 19 May 2024
Line 101:		Line 101:
	{{#ev:youtube\|https://www.youtube.com/watch?v=5mTEa7ZdM_g\|480\|right\|Video demonstration of a scalp block}}		{{#ev:youtube\|https://www.youtube.com/watch?v=5mTEa7ZdM_g\|480\|right\|Video demonstration of a scalp block}}
	[[Scalp block\|Scalp blocks]] are essential to achieve adequate analgesia during the awake phase.<ref name=":0" />		[[Scalp block\|Scalp blocks]] are essential to achieve adequate analgesia during the awake phase.<ref name=":0" />
	*Typically placed during the pre-awake phase using bupivacaine 0.5% or ropivacaine 0.5% (with epinephrine)		*Typically placed during the pre-awake phase using [[bupivacaine]] 0.5% or [[ropivacaine]] 0.5% (with epinephrine)
	**If faster onset is desired, can be pre-blocked with buffered lidocaine 2%		**If faster onset is desired, can be pre-blocked with buffered [[lidocaine]] 2%
	**Placement prior to pinning and exposure will reduce anesthetic requirements		**Placement prior to pinning and exposure will reduce anesthetic requirements
			*A single syringe with a combination of lidocaine, bupivacaine, [[sodium bicarbonate]], and [[epinephrine]] can provide fast onset, long duration, and reduced discomfort during injection<ref>{{Cite journal\|last=Best\|first=Corliss A\|last2=Best\|first2=Alyssa A\|last3=Best\|first3=Timothy J\|last4=Hamilton\|first4=Danielle A\|date=2015\|title=Buffered lidocaine and bupivacaine mixture – the ideal local anesthetic solution?\|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4459414/\|journal=Plastic Surgery\|volume=23\|issue=2\|pages=87–90\|doi=10.4172/plastic-surgery.1000913\|issn=2292-5503\|pmc=4459414\|pmid=26090348}}</ref>. For example, in a 10 mL syringe, a recommended mixture would be:
			**4.5 mL of 2% lidocaine with 1:100,000 epinephrine
			**4.5 mL of 0.5% bupivacaine with 1:200,000 epinephrine
			**0.4 mL of 8.4% sodium bicarbonate
	* Can be supplemented during the awake phase using buffered lidocaine 2%		* Can be supplemented during the awake phase using buffered lidocaine 2%

Chris.Rishel at 21:23, 30 October 2022

2022-10-30T21:23:03Z

← Older revision		Revision as of 14:23, 30 October 2022
Line 159:		Line 159:

	* If non-instrumented airway, sedation can be discontinued during closure and patient allowed to emerge after removal from pinned frame		* If non-instrumented airway, sedation can be discontinued during closure and patient allowed to emerge after removal from pinned frame
	* If LMA/ETT in place, ensure intact airway reflexes and smooth removal ~~with~~		* If LMA/ETT in place, ensure intact airway reflexes and smooth removal

	==Postoperative management==		==Postoperative management==

Chris.Rishel: Minor formatting and organization

2022-08-15T02:23:19Z

Minor formatting and organization

← Older revision		Revision as of 19:23, 14 August 2022
Line 62:		Line 62:
	\|Cardiovascular		\|Cardiovascular
	\|		\|
	Evaluate for comorbidities which may be exacerbated by intraoperative stress during the procedure (i.e. being under drapes, head clamped in Mayfield pins, surgical sounds, etc.).		* Evaluate for comorbidities which may be exacerbated by intraoperative stress during the procedure (i.e. being under drapes, head clamped in Mayfield pins, surgical sounds, etc.).
	Increased ICP may result in [[Cushing's 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>		* Increased ICP may result in [[Cushing's 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>
	\|-		\|-
	\|Pulmonary		\|Pulmonary
	\|		\|
	Significant comorbidities (e.g. advanced COPD requiring supplemental oxygen or history of exacerbation, asthma with history of exacerbations requiring rescue inhaler use, etc.) should be assessed in advance to determine suitability for this procedure.		* Significant comorbidities (e.g. advanced COPD requiring supplemental oxygen or history of exacerbation, asthma with history of exacerbations requiring rescue inhaler use, etc.) should be assessed in advance to determine suitability for this procedure.
			* Detailed airway exam to estimate risk of airway compromise during sedation.
			** OSA, morbid obesity, abnormal upper airway anatomy are relative contraindications to awake technique.
	Detailed airway exam to estimate risk of airway compromise during sedation. OSA, morbid obesity, abnormal upper airway anatomy are relative contraindications to awake technique.
	\|-		\|-
	\|Gastrointestinal		\|Gastrointestinal
Line 97:		Line 96:
	===Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. -->===		===Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. -->===
	*For patients who are used to a morning cup of coffee, consider caffeine 200 mg PO before surgery to reduce the risk of withdrawal headache<ref>{{Cite journal\|last=Potters\|first=Jan-Willem\|last2=Klimek\|first2=Markus\|date=2015\|title=Awake craniotomy: improving the patient's experience\|url=https://pubmed.ncbi.nlm.nih.gov/26263121/\|journal=Current Opinion in Anaesthesiology\|volume=28\|issue=5\|pages=511–516\|doi=10.1097/ACO.0000000000000231\|issn=1473-6500\|pmid=26263121\|via=}}</ref>		*For patients who are used to a morning cup of coffee, consider caffeine 200 mg PO before surgery to reduce the risk of withdrawal headache<ref>{{Cite journal\|last=Potters\|first=Jan-Willem\|last2=Klimek\|first2=Markus\|date=2015\|title=Awake craniotomy: improving the patient's experience\|url=https://pubmed.ncbi.nlm.nih.gov/26263121/\|journal=Current Opinion in Anaesthesiology\|volume=28\|issue=5\|pages=511–516\|doi=10.1097/ACO.0000000000000231\|issn=1473-6500\|pmid=26263121\|via=}}</ref>
	*~~glycopyrolate is~~ an ~~effective~~ antisialagogue		*[[Glycopyrrolate]] may be useful as an antisialagogue

	=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. -->===		=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. -->===
Line 128:		Line 127:
	*Place lines with field blocks using buffered lidocaine for patient comfort		*Place lines with field blocks using buffered lidocaine for patient comfort

	If using general anesthesia:<ref name=":1" />		If using general anesthesia:<ref name=":1">{{Cite journal\|last=Meng\|first=Lingzhong\|last2=McDonagh\|first2=David L.\|last3=Berger\|first3=Mitchel S.\|last4=Gelb\|first4=Adrian W.\|date=2017\|title=Anesthesia for awake craniotomy: a how-to guide for the occasional practitioner\|url=https://pubmed.ncbi.nlm.nih.gov/28181184/\|journal=Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie\|volume=64\|issue=5\|pages=517–529\|doi=10.1007/s12630-017-0840-1\|issn=1496-8975\|pmid=28181184\|via=}}</ref>

	*Induce with propofol		*Induce with propofol
Line 144:		Line 143:

	====Intraoperative seizures====		====Intraoperative seizures====
	Seizures may occur during intraoperative stimulation mapping. Rates of incidence vary widely, ranging between 3-16%.<ref name=":1" /> Untreated intraoperative seizures may precipitate catastrophic complications. If seizures are generalized they may induce breath holding, and valsalva. Increased intrathoracic pressure suddenly decreases venous drainage from the brain and transcranial herniation can occur rapidly.

	Intraoperative seizures must be rapidly recognized and treated~~, as postictal~~ delirium can preclude effective neuropsychological monitoring and necessitate abortion of the procedure. ~~Seizures~~ can ~~be treated using:~~<ref ~~name=":1"~~>{{Cite journal\|last=~~Meng~~\|first=~~Lingzhong~~\|last2=~~McDonagh~~\|first2=~~David L.~~\|last3=~~Berger~~\|first3=~~Mitchel S.~~\|last4=~~Gelb~~\|first4=~~Adrian W.~~\|date=~~2017~~\|title=~~Anesthesia for awake craniotomy~~: a ~~how~~-~~to guide for the occasional practitioner~~\|url=https://pubmed.ncbi.nlm.nih.gov/~~28181184~~/\|journal=~~Canadian~~ Journal of ~~Anaesthesia = Journal Canadien D'anesthesie~~\|volume=64\|issue=5\|pages=~~517–529~~\|doi=10.~~1007~~/~~s12630-017-0840-1~~\|issn=~~1496~~-~~8975~~\|pmid=~~28181184~~\|via=}}</ref>		* Seizures may occur during intraoperative stimulation mapping. Rates of incidence vary widely, ranging between 3-16%.<ref name=":1" />
			* Intraoperative seizures must be rapidly recognized and treated using:<ref name=":1" />
			**Cold water irrigation of the surgical field
			**Low doses of propofol (30-50 mg)
			* Untreated intraoperative seizures may precipitate catastrophic complications
			** Postictal delirium can preclude effective neuropsychological monitoring and necessitate abortion of the procedure.
			** Generalized seizures may induce breath holding, and valsalva. Increased intrathoracic pressure suddenly decreases venous drainage from the brain and transcranial herniation can occur rapidly.
			* There is limited evidence to support the use of levetiracetam for seizure prophylaxis.<ref>{{Cite journal\|last=Pourzitaki\|first=Chryssa\|last2=Tsaousi\|first2=Georgia\|last3=Apostolidou\|first3=Eirini\|last4=Karakoulas\|first4=Konstantinos\|last5=Kouvelas\|first5=Dimitrios\|last6=Amaniti\|first6=Ekaterini\|date=2016\|title=Efficacy and safety of prophylactic levetiracetam in supratentorial brain tumour surgery: a systematic review and meta-analysis\|url=https://pubmed.ncbi.nlm.nih.gov/26945547/\|journal=British Journal of Clinical Pharmacology\|volume=82\|issue=1\|pages=315–325\|doi=10.1111/bcp.12926\|issn=1365-2125\|pmc=4917799\|pmid=26945547\|via=}}</ref>

	*Cold water irrigation of the surgical field		==== Post-resection management ====
	*Low doses of propofol (30-~~50 mg)~~		Patients can typically be re-sedated after resection has been completed, though some surgeons prefer to keep patients awake to continue conscious neurological monitoring.

	~~There is limited evidence to support the use of levetiracetam for seizure prophylaxis.<ref>{{Cite journal\|last~~=~~Pourzitaki\|first~~=~~Chryssa\|last2~~=~~Tsaousi\|first2=Georgia\|last3=Apostolidou\|first3=Eirini\|last4=Karakoulas\|first4=Konstantinos\|last5=Kouvelas\|first5=Dimitrios\|last6=Amaniti\|first6=Ekaterini\|date=2016\|title=Efficacy~~ and ~~safety of prophylactic levetiracetam in supratentorial brain tumour surgery: a systematic review and meta-analysis\|url=https:~~/~~/pubmed~~.~~ncbi.nlm.nih.gov/26945547/\|journal=British Journal of Clinical Pharmacology\|volume=82\|issue=1\|pages=315–325\|doi=10.1111/bcp.12926\|issn=1365~~-~~2125\|pmc~~=~~4917799\|pmid~~=~~26945547\|via~~=~~}}</ref>~~		===Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===

	~~===Emergence<!~~-~~- List~~ and~~/or describe any important considerations related~~ to ~~the emergence~~ from ~~anesthesia for this case. --> ===~~		* If non-instrumented airway, sedation can be discontinued during closure and patient allowed to emerge after removal from pinned frame
			* If LMA/ETT in place, ensure intact airway reflexes and smooth removal with

	==Postoperative management==		==Postoperative management==

SLindberg: minor addition

2022-08-14T20:29:37Z

minor addition

← Older revision		Revision as of 13:29, 14 August 2022
Line 42:		Line 42:
	**May experience dry mouth		**May experience dry mouth
	*Patient will be able to communicate with the OR staff at all times while awake		*Patient will be able to communicate with the OR staff at all times while awake
			*Patient should be encouraged to communicate any and all concerns during the operation
			**discomfort with position should be addressed early before pt becomes distressed
			**presence of aura, indicating impending seizure
	*Patient will be asked to perform tasks and/or answer questions throughout the procedure		*Patient will be asked to perform tasks and/or answer questions throughout the procedure

Line 65:		Line 68:
	\|		\|
	Significant comorbidities (e.g. advanced COPD requiring supplemental oxygen or history of exacerbation, asthma with history of exacerbations requiring rescue inhaler use, etc.) should be assessed in advance to determine suitability for this procedure.		Significant comorbidities (e.g. advanced COPD requiring supplemental oxygen or history of exacerbation, asthma with history of exacerbations requiring rescue inhaler use, etc.) should be assessed in advance to determine suitability for this procedure.


			Detailed airway exam to estimate risk of airway compromise during sedation. OSA, morbid obesity, abnormal upper airway anatomy are relative contraindications to awake technique.
	\|-		\|-
	\|Gastrointestinal		\|Gastrointestinal
Line 91:		Line 97:
	===Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. -->===		===Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. -->===
	*For patients who are used to a morning cup of coffee, consider caffeine 200 mg PO before surgery to reduce the risk of withdrawal headache<ref>{{Cite journal\|last=Potters\|first=Jan-Willem\|last2=Klimek\|first2=Markus\|date=2015\|title=Awake craniotomy: improving the patient's experience\|url=https://pubmed.ncbi.nlm.nih.gov/26263121/\|journal=Current Opinion in Anaesthesiology\|volume=28\|issue=5\|pages=511–516\|doi=10.1097/ACO.0000000000000231\|issn=1473-6500\|pmid=26263121\|via=}}</ref>		*For patients who are used to a morning cup of coffee, consider caffeine 200 mg PO before surgery to reduce the risk of withdrawal headache<ref>{{Cite journal\|last=Potters\|first=Jan-Willem\|last2=Klimek\|first2=Markus\|date=2015\|title=Awake craniotomy: improving the patient's experience\|url=https://pubmed.ncbi.nlm.nih.gov/26263121/\|journal=Current Opinion in Anaesthesiology\|volume=28\|issue=5\|pages=511–516\|doi=10.1097/ACO.0000000000000231\|issn=1473-6500\|pmid=26263121\|via=}}</ref>
			*glycopyrolate is an effective antisialagogue

	=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. -->===		=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. -->===
Line 111:		Line 118:

	===Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. -->===		===Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. -->===
	The pre-awake phase of the procedure involves line placement, positioning, and cranial opening. This phase may be achieved using MAC or general anesthesia with similar outcomes, and largely depends on institution and practitioner preference.<ref name=":2" />		The pre-awake phase of the procedure involves line placement, positioning, and cranial opening. This phase may be achieved using MAC or general anesthesia with similar outcomes, and largely depends on institution and practitioner preference.<ref name=":2" /> The decision on what technique will be informed by experience with the surgical team, a common determining factor is the duration of the pre-awake phase.

	If using MAC:		If using MAC:
Line 120:		Line 127:
	**Propofol 25-50 mcg/kg/min		**Propofol 25-50 mcg/kg/min
	*Place lines with field blocks using buffered lidocaine for patient comfort		*Place lines with field blocks using buffered lidocaine for patient comfort


	If using general anesthesia:<ref name=":1" />		If using general anesthesia:<ref name=":1" />
Line 138:		Line 144:

	====Intraoperative seizures====		====Intraoperative seizures====
	Seizures may occur during intraoperative stimulation mapping. Rates of incidence vary widely, ranging between 3-16%.<ref name=":1" />		Seizures may occur during intraoperative stimulation mapping. Rates of incidence vary widely, ranging between 3-16%.<ref name=":1" /> Untreated intraoperative seizures may precipitate catastrophic complications. If seizures are generalized they may induce breath holding, and valsalva. Increased intrathoracic pressure suddenly decreases venous drainage from the brain and transcranial herniation can occur rapidly.

	Intraoperative seizures must be rapidly recognized and treated, as postictal delirium can preclude effective neuropsychological monitoring and necessitate abortion of the procedure. Seizures can be treated using:<ref name=":1">{{Cite journal\|last=Meng\|first=Lingzhong\|last2=McDonagh\|first2=David L.\|last3=Berger\|first3=Mitchel S.\|last4=Gelb\|first4=Adrian W.\|date=2017\|title=Anesthesia for awake craniotomy: a how-to guide for the occasional practitioner\|url=https://pubmed.ncbi.nlm.nih.gov/28181184/\|journal=Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie\|volume=64\|issue=5\|pages=517–529\|doi=10.1007/s12630-017-0840-1\|issn=1496-8975\|pmid=28181184\|via=}}</ref>		Intraoperative seizures must be rapidly recognized and treated, as postictal delirium can preclude effective neuropsychological monitoring and necessitate abortion of the procedure. Seizures can be treated using:<ref name=":1">{{Cite journal\|last=Meng\|first=Lingzhong\|last2=McDonagh\|first2=David L.\|last3=Berger\|first3=Mitchel S.\|last4=Gelb\|first4=Adrian W.\|date=2017\|title=Anesthesia for awake craniotomy: a how-to guide for the occasional practitioner\|url=https://pubmed.ncbi.nlm.nih.gov/28181184/\|journal=Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie\|volume=64\|issue=5\|pages=517–529\|doi=10.1007/s12630-017-0840-1\|issn=1496-8975\|pmid=28181184\|via=}}</ref>
Line 144:		Line 150:
	*Cold water irrigation of the surgical field		*Cold water irrigation of the surgical field
	*Low doses of propofol (30-50 mg)		*Low doses of propofol (30-50 mg)


	There is limited evidence to support the use of levetiracetam for seizure prophylaxis.<ref>{{Cite journal\|last=Pourzitaki\|first=Chryssa\|last2=Tsaousi\|first2=Georgia\|last3=Apostolidou\|first3=Eirini\|last4=Karakoulas\|first4=Konstantinos\|last5=Kouvelas\|first5=Dimitrios\|last6=Amaniti\|first6=Ekaterini\|date=2016\|title=Efficacy and safety of prophylactic levetiracetam in supratentorial brain tumour surgery: a systematic review and meta-analysis\|url=https://pubmed.ncbi.nlm.nih.gov/26945547/\|journal=British Journal of Clinical Pharmacology\|volume=82\|issue=1\|pages=315–325\|doi=10.1111/bcp.12926\|issn=1365-2125\|pmc=4917799\|pmid=26945547\|via=}}</ref>		There is limited evidence to support the use of levetiracetam for seizure prophylaxis.<ref>{{Cite journal\|last=Pourzitaki\|first=Chryssa\|last2=Tsaousi\|first2=Georgia\|last3=Apostolidou\|first3=Eirini\|last4=Karakoulas\|first4=Konstantinos\|last5=Kouvelas\|first5=Dimitrios\|last6=Amaniti\|first6=Ekaterini\|date=2016\|title=Efficacy and safety of prophylactic levetiracetam in supratentorial brain tumour surgery: a systematic review and meta-analysis\|url=https://pubmed.ncbi.nlm.nih.gov/26945547/\|journal=British Journal of Clinical Pharmacology\|volume=82\|issue=1\|pages=315–325\|doi=10.1111/bcp.12926\|issn=1365-2125\|pmc=4917799\|pmid=26945547\|via=}}</ref>

Chris.Rishel: Minor additions to regional and induction sections

2022-07-01T14:48:38Z

Minor additions to regional and induction sections

← Older revision		Revision as of 07:48, 1 July 2022
Line 94:		Line 94:
	=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. -->===		=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. -->===
	{{#ev:youtube\|https://www.youtube.com/watch?v=5mTEa7ZdM_g\|480\|right\|Video demonstration of a scalp block}}		{{#ev:youtube\|https://www.youtube.com/watch?v=5mTEa7ZdM_g\|480\|right\|Video demonstration of a scalp block}}
	[[Scalp block\|Scalp blocks]] are essential to achieve adequate analgesia during the awake phase<ref name=":0" />		[[Scalp block\|Scalp blocks]] are essential to achieve adequate analgesia during the awake phase.<ref name=":0" />
	*Typically placed during the pre-awake phase using bupivacaine 0.5% or ropivacaine 0.5% (with epinephrine)		*Typically placed during the pre-awake phase using bupivacaine 0.5% or ropivacaine 0.5% (with epinephrine)
	* Can be supplemented during the awake phase using buffered lidocaine 1% ~~(with epinephrine)~~		**If faster onset is desired, can be pre-blocked with buffered lidocaine 2%
			**Placement prior to pinning and exposure will reduce anesthetic requirements
			* Can be supplemented during the awake phase using buffered lidocaine 2%

	==Intraoperative management==		==Intraoperative management==
Line 116:		Line 118:
	**Midazolam 1-10 mg IV (titrated incremental doses)		**Midazolam 1-10 mg IV (titrated incremental doses)
	**Dexmedetomidine 0.2-0.7 mcg/kg/hr		**Dexmedetomidine 0.2-0.7 mcg/kg/hr
			**Propofol 25-50 mcg/kg/min
	*Place lines with field blocks using buffered lidocaine for patient comfort		*Place lines with field blocks using buffered lidocaine for patient comfort

Line 150:		Line 153:

	===Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. -->===		===Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. -->===

			* Typically ICU for frequent neuro exams

	===Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===		===Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===

			* Scalp block will provide analgesia for 12-16 hours
			* If supplemental analgesia is required
			** Acetaminophen
			** Use narcotics with caution as can interfere with neurologic examination

	===Potential complications<!-- List and/or describe any potential postoperative complications for this case. -->===		===Potential complications<!-- List and/or describe any potential postoperative complications for this case. -->===

Chris.Rishel: Text replacement - "Art line" to "Arterial line"

2022-04-05T19:40:09Z

Text replacement - "Art line" to "Arterial line"

← Older revision		Revision as of 12:40, 5 April 2022
Line 6:		Line 6:
	LMA		LMA
	\| lines_access = PIV x2		\| lines_access = PIV x2
	~~Art~~ line		Arterial line
	Central line		Central line
	\| monitors = Standard		\| monitors = Standard

Chris.Rishel at 05:53, 5 April 2022

2022-04-05T05:53:44Z

← Older revision		Revision as of 22:53, 4 April 2022
Line 59:		Line 59:
	\|Cardiovascular		\|Cardiovascular
	\|		\|
	Evaluate for comorbidities which may be exacerbated by intraoperative stress during the procedure (i.e. being under drapes, head clamped in Mayfield pins, surgical sounds, etc.)		Evaluate for comorbidities which may be exacerbated by intraoperative stress during the procedure (i.e. being under drapes, head clamped in Mayfield pins, surgical sounds, etc.).
	Increased ICP may result in [[Cushing's 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>		Increased ICP may result in [[Cushing's 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>
	\|-		\|-

Chris.Rishel at 05:53, 5 April 2022

2022-04-05T05:53:06Z

← Older revision		Revision as of 22:53, 4 April 2022
Line 1:		Line 1:
	{{Infobox surgical case reference		{{Infobox surgical case reference
	\| anesthesia_type =		\| anesthesia_type = Scalp block
	\| airway =		MAC
	\| lines_access =		GA-awake-GA
	\| monitors =		\| airway = Noninvasive O2
	\| considerations_preoperative =		LMA
	\| considerations_intraoperative =		\| lines_access = PIV x2
			Art line
			Central line
			\| monitors = Standard
			5-lead ECG
			Temperature
			Urine output
			ABP
			CVP
			Neuromonitoring
			± Precordial doppler
			\| considerations_preoperative = Comprehensive patient consultation
			Baseline neuro exam
			\| considerations_intraoperative = Scalp block required
			Risk of seizure
	\| considerations_postoperative =		\| considerations_postoperative =
	}}An '''awake craniotomy''' is a surgical procedure 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. Patients are typically sedated during line placement and cranial opening, and then awakened once the dura is opened. 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.		}}An '''awake craniotomy''' is a surgical procedure 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. Patients are typically sedated during line placement and cranial opening, and then awakened once the dura is opened. 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.