Awake craniotomy
Awake craniotomy
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DOI：
10.1097/eja.0b013e32833000c5
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发表时间：
2009-11-01
影响因子：
3.6
通讯作者：
Hans, Pol
中科院分区：
文献类型：
--
作者：
Bonhomme, Vincent;Franssen, Collette;Hans, Pol
清醒开颅手术已经成为一种越来越频繁的手术。本文就其麻醉管理原则作一综述。描述了实现麻醉目的的方法，强调了决定手术成功的几个要点。仔细和充分的患者选择和准备是强制性的，干预团队必须是一个熟练的团队。选择清醒技术或全身麻醉取决于几个因素，包括阻塞性呼吸暂停、癫痫发作、恶心和呕吐的风险，患者的合作能力，以及病变的位置。术中麻醉管理的主要挑战依赖于根据手术事件的顺序快速调整镇静和止痛水平的能力，同时确保血流动力学稳定、充足的通风和对最终电生理记录的最小干扰。在整个手术过程中，必须根据预定义的指南预测和处理并发症。仍然需要更多的前瞻性随机临床试验来提高清醒开颅手术的安全性和有效性，并与更传统的麻醉管理相比较来验证这项技术。欧洲麻醉学杂志26：906-912(C)2009欧洲麻醉学学会。
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. Eur J Anaesthesiol 26:906-912 (C) 2009 European Society of Anaesthesiology.