Recently, the Department of Anesthesiology and the Department of Neurosurgery of Weifang City People’s Hospital jointly applied intraoperative awakening technology to successfully perform functional area tumor resection for a patient with intracranial space occupying.
Intraoperative awakening is also called surgical awakening, which means that in the state of intraoperative awakening, combined with electrophysiological positioning technology and neurological function detection, it is possible to remove the lesions in the functional brain area as much as possible. Protect brain function.
This technique was originally used in surgeries such as scoliosis correction. In the past, conventional brain tumor resection was performed under general anesthesia. The patient was completely unconscious during the operation, and the doctor could not judge whether the patient’s language area and motor area were damaged during the operation, which virtually increased the risk of the operation. The awake craniotomy is aimed at lesions in the functional area of the brain. It is supported by a variety of high-end technologies such as wake-up anesthesia, neuroelectrophysiological monitoring, neuronavigation, microneurosurgery, and functional magnetic resonance. , a comprehensive surgical technique for maximum resection of brain tumors. During the awake craniotomy, the doctor can detect which parts of the brain are “forbidden areas” by communicating with the patient, preventing these important functional areas from being mistakenly cut during tumor resection, and avoiding serious consequences such as paralysis and aphasia after surgery.
Key steps to wake up anesthesia during surgery
1. Sufficient analgesia during opening and closing of the skull, and able to tolerate surgery;
< p>2. Smooth transition between anesthesia and awake;
3. The patient is sufficiently awake during the intraoperative electrical stimulation of the cortex, and the neurological function test is performed;
4. Maintain the patient’s life such as breathing and circulation Signs are safe and stable.
Commonly used anesthesia methods for intraoperative awakening
At present, there are two main anesthesia methods commonly used for intraoperative awakening. One is Asleep-Awake-Asleep (AAA), that is, general anesthesia is used to control the airway before the wake-up period, usually a laryngeal mask is used, and the patient is expected to appear during the wake-up period After stable spontaneous breathing, the laryngeal mask was removed, and the patient was put back into general anesthesia after awakening and the laryngeal mask was reset. The other is Monitored AnesthesiaCare (MAC), which refers to the use of lower doses of sedative and analgesic drugs throughout the procedure, and spontaneous breathing is preserved, usually without the need for an invasive airway equipment.
The core difference between AAA and MAC techniques is that the former generally uses a laryngeal mask to control the airway, while the latter does not control the airway and preserves the patient’s spontaneous breathing. No matter which technique is used, patients should be fully educated before surgery, the indications and contraindications should be mastered, reasonable drug management strategies and airway protection strategies should be used during surgery, and end-tidal carbon dioxide partial pressure and EEG bispectral index should be closely monitored. Important indicators are also inseparable from the close communication and multidisciplinary cooperation between anesthesiologists, neurosurgeons, and electrophysiological monitoring personnel.
Will the patient feel pain after the intraoperative awakening?
During craniotomy, the pain sensation only comes from the steps of opening and closing the craniotomy. Awake craniotomy requires complete scalp nerve block, and the doctor will also perform local incision anesthesia in the surgical incision. At the same time, during the operation, the anesthesiologist will adjust the depth of anesthesia according to the operation steps and give the patient different doses of analgesic drugs, so the patient will not feel obvious pain.
How can patients overcome their inner fears?
For patients, it takes enough courage to accept intraoperative wake-up surgery. Just imagine, when your “brain hole” is wide open, but you are still aware of the situation you are facing, won’t you be afraid? Therefore, the doctor will conduct sufficient communication and psychological counseling with the patient 2 to 3 days before the operation, and will inform the patient of the relevant steps of the operation, the monitoring tasks that need to be completed, and the precautions for the operation.
As a still-evolving technology, intraoperative arousal requires more prospective clinical studies to improve its effectiveness and improve the quality of life of patients. It is believed that with the continuous development of anesthesia technology and neuroelectrophysiological technology, intraoperative awakening technology will play an increasingly important role in protecting nerve function and improving the quality of life of patients after surgery.