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Updated: May 13, 2026
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Intra-Operative Behavioral Tasks in Awake Humans Undergoing Deep Brain Stimulation Surgery
Published on: January 6, 2011
Patients selection for awake neurosurgery
J D Dreier1, B Williams, D Mangar
1Critical Care Fellow, Department of Anesthesiology and Critical Care Medicine, University of South Florida, Tampa, Florida.
HSR Proceedings in Intensive Care & Cardiovascular Anesthesia
|February 27, 2013
Summary
This study introduces a new decision algorithm to improve patient selection for awake craniotomy, a procedure beneficial for neurocognitive testing during surgery. The algorithm simplifies anesthetic choices and prevents inappropriate patient assignments.
Area of Science:
- Neurosurgery
- Anesthesiology
- Neuroscience
Background:
- Awake craniotomy offers benefits for neurocognitive testing during surgery, particularly for procedures in eloquent brain areas or for epilepsy foci.
- Patient selection for awake craniotomy can be challenging, necessitating clear criteria.
Purpose of the Study:
- To develop and present a novel decision algorithm for selecting appropriate patients for awake craniotomy.
- To streamline the preoperative anesthetic selection process and minimize errors.
Main Methods:
- A retrospective chart review of 397 craniotomies performed between 2005 and 2006 was conducted.
- Data on indications and anesthetic techniques (awake vs. general) were analyzed to develop a decision tree.
- A specific sedation and anesthesia sequence involving dexmedetomidine, propofol, LMA, skull block, desflurane, and remifentanil was utilized.
Main Results:
- Out of 397 craniotomies, 79 patients (20%) underwent awake craniotomy.
- The developed decision tree effectively guided the selection of patients for awake procedures.
- The described anesthetic technique, including specific agents and airway management, proved successful.
Conclusions:
- The proposed decision algorithm simplifies preoperative anesthetic selection for awake craniotomy.
- This approach helps prevent the erroneous assignment of patients unsuitable for awake procedures.
- The described anesthetic sequence and decision-making tool are effective for optimizing patient selection.
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