Brain tumor surgery with awake patient, experience at Hospital Escalante Pradilla

Abstract

Aim: To describe the experience of three patients undergoing craniotomy for tumor resection under the awake-awake-awake modality and to develop an anesthetic intervention scheme with medications available at the institutional level, to maintain the patients with a level of consciousness sufficient to maintain the interaction during the intraoperative period.

Methods: The case of three patients undergoing craniotomy and tumor resection under the awake-awake-awake modality is presented. Non-invasive monitoring and blockage of the scalp and surgical area were used.
Results: Three male patients with intracerebral tumors underwent surgery, a wide resection of the lesions was achieved, the patients did not require invasive airway management, they adequately went through the planned stages of the procedure. All patients were referred to the recovery service conscious and oriented, with stable vital signs. The process was optimized to use medications and available resources with a proposed anesthetic protocol.
Conclusion: The awake-awake-awake technique allows the patient to remain more comfortable and cooperative during the stages of surgery; adequate scalp blockade leads to less drug use and better responses. The technique used and the medication protocol developed allows the procedure to be performed without the need to secure the airway in the first and or last phase. It is possible to perform  neurosurgical interventions with the patient awake in hospitals located in rural areas of Costa Rica.