Selective neuromuscular blockade for intraoperative electrocorticography

Local anesthesia is advocated for cortical mapping in certain neurological procedures. Occasionally, however, a modified general anesthetic is necessary. We describe a technique of balanced anesthesia in which the arm opposite to the craniotomy is selectively isolated from the effect of the neuromuscular blocking agent and hence preserves its motor response to cortical stimulation. The technique secures complete immobility of the patient during mapping of the brain, shortens the stimulation time, facilitates the localization of the motor cortex, precludes the development of full-blown seizures, increases safety and is well tolerated.