Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942006000400008
Brazilian Journal of Anesthesiology
Clinical Information

Dexmedetomidina para teste neurocognitivo em craniotomia com o paciente acordado: relato de caso

Dexmedetomidine for neurocognitive testing in awake craniotomy: case report

Marcelo Cursino Pinto dos Santos; Ronaldo Contreras Oliveira Vinagre

http://dx.doi.org/10.1590/S0034-70942006000400008 Braz J Anesthesiol, vol.56, n4, p.402-407, 2006
PDF Português
PDF English
Downloads: 0
Views: 1003

Resumo

JUSTIFICATIVA E OBJETIVOS: As ressecções tumorais em áreas eloqüentes do cérebro são realizadas com mais segurança utilizando-se testes cognitivos para identificação exata desses locais. Os pacientes devem estar acordados, confortáveis e colaborativos para que se identifiquem com clareza as áreas que devem ser preservadas. O objetivo deste relato foi apresentar intervenção cirúrgica realizada com o paciente acordado, utilizando sevoflurano no período inicial, sem intubação traqueal e a dexmedetomidina, posteriormente, técnica que permitiu a realização dos testes de avaliação motora e da fala. RELATO DO CASO: Paciente do sexo masculino, 27 anos, estado físico ASA I, com tumor cerebral. Na sala cirúrgica, sem medicação pré-anestésica, foi administrado midazolam (1 mg), induzida a anestesia geral com propofol (80 mg). A manutenção foi realizada com O2, N2O e sevoflurano sob máscara para punção da artéria radial direita, cateterismo vesical e infiltração da área cirúrgica. Essa fase durou cerca de 20 minutos, com início da infusão de dexmedetomidina nos últimos 10 minutos, para manter o nível de sedação Ramsay 2. Depois, foi realizado o mapeamento cortical (75 minutos). Seguiu-se a ressecção tumoral, com o paciente sedado recebendo doses maiores de dexmedetomidina. Observou-se estabilidades hemodinâmica e respiratória, tendo o procedimento transcorrido sem intercorrências, com duração total de cinco horas. Após o término da intervenção cirúrgica o paciente foi encaminhado ao CTI, sem alterações neurológicas, tendo alta para a enfermaria no dia seguinte. CONCLUSÕES: A craniotomia com o paciente acordado e o adequado mapeamento das áreas corticais de fala e motora foram realizados com sucesso, por meio da infusão contínua de dexmedetomidina. Houve plena satisfação do paciente e da equipe cirúrgica com a técnica.

Palavras-chave

CIRURGIA, Neurocirurgia, DROGAS

Abstract

BACKGROUND AND OBJECTIVES: Tumor resections in the speech areas of the brain are more safely done using cognitive tests to determine their exact location. Patients must be awake, comfortable, and cooperative for the precise identification of the areas to be preserved. The objective of this report is to present a surgical procedure done with the patient awake, without endotracheal intubation, using sevofluorane initially, followed by dexmedetomidine. This technique allowed the realization of motor and speech evaluation tests. CASE REPORT: Twenty-seven years old male patient, physical status ASA I, with a brain tumor. In the operating room, without pre-anesthetic medication, midazolam (1 mg) was administered, and general anesthesia was induced with propofol (80 mg). Maintenance was done with O2, N2O, and sevofluorane, with a mask, for catheterization of the right radial artery, introduction of a vesical catheter, and infiltration of the surgical site. This phase lasted around 20 minutes, and the infusion of dexmedetomidine was initiated in the last 10 minutes to maintain a level of sedation Ramsay score 2. Cortical mapping followed (75 minutes). Afterwards, tumor resection was done while the patient remained sedated with higher doses of dexmedetomidine. Hemodynamic and respiratory parameters remained stable, and the procedure was performed without complications, lasting a total of five hours. After the surgical procedure the patient was transferred to the ICU. He did not develop any neurological changes, being discharged to a regular ward the following day. CONCLUSIONS: Awake craniotomy with the proper mapping of speech and motor cortical areas was successfully done with the continuous infusion of dexmedetomidine. Both the patient and the surgical team were pleased with the technique.

Keywords

DRUGS, SURGERY, Neurosurgery

References

Gugino LD, Aglio LS, Raymond SA. Intraoperative cortical function localization techniques. Techniques Neurosurg. 2001;7:19-32.

Aglio LS, Gugino LD. Conscious sedation for intraoperative neurosurgical procedures. Techniques Neurosurg. 2001;7:52-60.

Sarang A, Dinsmore J. Anaesthesia for awake craniotomy: evolution of a technique that facilitates neurological testing. Br J Anaesth. 2003;90:161-165.

Mack PF, Perrine K, Kobylarz E. Dexmedetomidine and neurocognitive testing in awake craniotomy. J Neurosurg Anesthesiol. 2004;16:20-25.

Ard J, Doyle W, Bekker A. Awake craniotomy with dexmedetomidine in pediatric patients. J Neurosurg Anesthesiol. 2003;15:263-266.

Manninen P, Contreras J. Anesthetic considerations for craniotomy in awake patients. Int Anesthesiol Clin. 1986;24:157-174.

Jones H, Smith M. Awake craniotomy: Continuing education in anaesthesia. Crit Care Med Pain. 2004;14:189-192.

Ard JL, Bekker AY, Doyle WK. Dexmedetomidine in awake craniotomy: a technical note. Surg Neurol. 2005;63:114-117.

Archer DP, McKenna JM, Morin L. Conscious-sedation analgesia during craniotomy for epilepsy: a review of 354 consecutive cases. Can J Anaesth. 1988;35:338-344.

Danks RA, Rogers M, Aglio LS. Patient tolerance of craniotomy performed with the patient under local anesthesia and monitored conscious sedation. Neurosurgery. 1998;42:28-36.

Welling EC, Donegan J. Neuroleptanalgesia using alfentanil for awake craniotomy. Anesth Analg. 1999;68:57-60.

Bekker AY, Kaufman B, Samir H. The use of dexmedetomidine infusion for awake craniotomy. Anesth Analg,. 2001;92:1251-1253.

O'Riain S, Cunningham AJ. Dexmedetomidine and neurocognitive testing in awake craniotomy. Surv Anesthesiol. 2005;49:83-84.

Mantz J. Alpha2-adrenoceptor agonists: analgesia, sedation, anxiolysis, haemodynamics, respiratory function and weaning. Best Pract Clin Anaesthesiol. 2000;14:433-448.

Jaakola ML. Intra-operative use of alpha2-adrenoceptor agonists. Best Pract Clin Anaesthesiol. 2000;14:335-345.

Hall JE, Uhrich TD, Barney JA. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg. 2000;90:699-705.

Bustillo MA, Lazar RM, Finck AD. Dexmedetomidine may impair cognitive testing during endovascular embolization of cerebral arteriovenous malformation: a retrospective case report series. J Neurosurg Anesthesiol. 2002;14:209-212.

Salonen M, Reid K, Maze M. Synergistic interaction between alpha2-adrenergic agonists and benzodiazepines in rats. Anesthesiology. 1992;76:1004-1011.

5dd42b790e8825e229c63493 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections