Practical guidance for monitored anesthesia care during awake craniotomy

Area of Science:

• Neurosurgery
• Anesthesiology

Background:

• Awake craniotomy requires specialized anesthetic management.
• Monitored anesthesia care (MAC) presents a feasible anesthetic option.

Purpose of the Study:

• To evaluate the feasibility and safety of MAC for awake craniotomy.
• To highlight key considerations for patient selection and management.

Main Methods:

• Thorough pre-anesthetic evaluation focusing on airway risks.
• Neuropsychiatric counseling for patient cooperation.
• Analgesia via scalp nerve blocks (e.g., zygotemporal nerve block) and local infiltration.
• Emphasis on patient positioning for safety and comfort.

Main Results:

• MAC is a viable anesthetic strategy for awake craniotomy.
• Patient selection and rapport-building are critical for success.
• Mild to moderate transient pain may occur, managed with sedatives or analgesics.
• Serious adverse events are rare but possible.

Conclusions:

• MAC is a safe and effective anesthetic option for awake craniotomy.
• Careful patient assessment and management optimize outcomes.
• MAC holds potential for improving quality of life for specific patient populations.