Incidence and Risk Factors of Complication in Awake Craniotomy: A10-year Retrospective Study
Keywords:
anesthetic techniques, awake craniotomy, complicationsAbstract
Background: Awake craniotomies for eloquent area lesion
resection and deep brain stimulation (DBS) have become
trend toward increasingly. Awake test is a challenging task
to perform adequate anesthesia without causing a
problem.
Methods: All awake craniotomy records from 2006 to 2016
in Ramathibodi hospital were reviewed. The anesthetic
techniques were all asleep-awake-asleep techniques.
Patients were divided into 3 methods according to the
ventilation techniques. First method was assisted or
controlled ventilation method (AC) during first asleep
phase. Patients in second method were on spontaneous
ventilation method (SP) throughout the surgery. Last
method, using nasopharyngeal airway with connector to
inhalation anesthetic agents, created a continuous positive
airway pressure (CPAP) while spontaneous breathing. Our
study reviewed complications and risk factors associated
with complications.
Results: Sixty-six patients were reviewed. Twenty-five
cases from 30 cases (83.33%) in AC method found
complications, mostly in neurological problems. Nineteen
cases from 33 cases (57.57%) in SP method had
complications, mainly in respiratory events. The serious
respiratory-related problems including upper airway
obstruction, reintubation, venous air embolism were only
found in DBS from SP method. In CPAP method, all 3
cases had complications. The significant associations with
complications were patients with seizure (p=0.032),
smoking patients (p=0.048), using fentanyl 100
micrograms or more (p=0.008), AC method (p=0.028),
tumor removal operation (p=0.015). There were inversely
related with complications by using dexmedetomidine
(p=0.042), SP method (p=0.007) and DBS (p=0.014).
Conclusion: Complications in awake craniotomy were
massive. Anesthesiologists must be aware throughout the
procedures and avoid factors that associated with
perioperative complications.
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