Awake Craniotomy without Invasive Blood Pressure Monitoring

To assess the safety of foregoing invasive monitoring in a select group of patients undergoing awake craniotomy for supratentorial tumor resection.

Awake craniotomies were performed for tumor resection without invasive blood pressure monitoring when there was no preexisting cardiopulmonary indication as determined by the attending anesthesiologist according to institutional protocol. Noninvasive monitoring was performed every 3-5 minutes intraoperatively and then every 15 minutes in the recovery room for 4 hours before transfer to the ward.

At a single tertiary care hospital, 74 consecutive awake surgeries were performed with noninvasive blood pressure monitoring. Among patients, 39 (52.7%) were male, 42 (83.8%) had infiltrative primary brain tumors, 2 (2.7%) had a history of coronary artery disease, 6 (8.1%) were diabetics, 10 (29.7%) were smokers, and 22 (29.7%) were on antihypertensive medications preoperatively. American Society of Anesthesiologists classification was I in 1.4% of patients, II in 36.4%, III in 60.8%, and IV in 1.4%. Intraoperative vasoactive medications were administered in 21 (28.4%) patients; 8 (38%) of these were on antihypertensive agents preoperatively. Vasodilators were administered in 13 (61.9%) patients, vasopressors were given in 6 (28.6%) patients, and both vasodilators and vasopressors were given in 2 (9.5%) patients. One patient experienced a lenticulostriate artery stroke intraoperatively, and 1 patient experienced atrial fibrillation 1 week postoperatively. There were no other perioperative anesthetic, hemorrhagic, renal, or cardiopulmonary complications.

Intraoperative physiologic control and surgical site complication avoidance do not warrant routine invasive blood pressure monitoring during awake craniotomy for tumor resection.