A Retrospective Analysis of a Remifentanil/Propofol General Anesthetic for Craniotomy Before Awake Functional Brain Mapping

We performed this study to summarize drug dosing, physiologic responses, and anesthetic complications from an IV general anesthetic technique for patients undergoing craniotomy for awake functional brain mapping. Review of 98 procedures revealed “most rapid” IV infusion rates for remifentanil 0.05,...

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Bibliographic Details
Published in:	Anesthesia and analgesia Vol. 101; no. 2; pp. 502 - 508
Main Authors:	Keifer, John C., Dentchev, Dimitar, Little, Kenneth, Warner, David S., Friedman, Allan H., Borel, Cecil O.
Format:	Journal Article
Language:	English
Published:	Hagerstown, MD International Anesthesia Research Society 01-08-2005 Lippincott
Subjects:	Adolescent Adult Aged Anesthesia Anesthesia, General - adverse effects Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anesthetics, Intravenous - adverse effects Biological and medical sciences Brain Mapping Brain Neoplasms - diagnosis Brain Neoplasms - surgery Child Cognition - physiology Craniotomy Efferent Pathways - physiology Female Humans Male Medical sciences Middle Aged Neurologic Examination Piperidines - adverse effects Propofol - adverse effects Retrospective Studies Survival Analysis Visual Perception - drug effects Wakefulness Agonist General anesthetic μ Opioid receptor Opiates Anesthesia Propofol Sedative Narcotic analgesic Remifentanil Encephalon
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Summary:	We performed this study to summarize drug dosing, physiologic responses, and anesthetic complications from an IV general anesthetic technique for patients undergoing craniotomy for awake functional brain mapping. Review of 98 procedures revealed “most rapid” IV infusion rates for remifentanil 0.05, 0.05–0.09 μg · kg−1 · min−1 and propofol 115, 100–150 μg · kg−1 · min−1. The infusions lasted for 78, 58-98 min. Intraoperative emergence from general anesthesia was 9 (6–13) min after discontinuing IV infusions to allow for brain mapping and was independent of infusion duration and duration of craniotomy before mapping. Spontaneous ventilation was generally satisfactory during drug infusion, as evidenced by Sao2 = 95% (92%–98%) and Paco2 = 50 (47–55) mm Hg. However, we recorded at least one 30-s epoch of apnea in 69 of 96 patients. Maximum systolic arterial blood pressure was 150 (139–175) mm Hg and minimal systolic arterial blood pressure was 100 (70–150) mm Hg during drug infusion. Three patients experienced intraoperative seizures. Two patients did not tolerate the awake state and required reinduction of general anesthesia. No patients required endotracheal intubation or discontinuation of surgery. This general anesthetic technique is effective for craniotomy with awake functional brain mapping and offers an alternative to continuous wakefulness or other IV sedation techniques.
ISSN:	0003-2999 1526-7598
DOI:	10.1213/01.ANE.0000160533.51420.44