Anesthesia for awake craniotomy in head sharps injury
Fikret Özerdem, Mehmet Tepe, Abdulkadir Demir
Adıyaman Üniversitesi Eğitim Araştırma Hastanesi
Giriş: Awake craniotomy is a technique that allows real-time patient feedback during the surgical procedure. In awake craniotomy, the role of anesthesia providers is critical in such surgical interventions, as patients need good sedation by opening and closing the bone flap without any respiratory depression.(1,2)
Olgu: A 35-year-old male patient was evaluated in the emergency department. Glasgow coma scale (gcs) was 15. Vital signs were BP 115/75 mmHg, HR 80 beats/min, SpO2 100, and body temperature 36.5 °C. In the brain tomography, it was seen that a knife fragment was stuck in the left parietal bone. There was no evidence of hemorrhage originating from the parenchyma in the brain, and only pneumocephaly was observed. There was no neurological deficit. It was given intravenous (iv) 2 mg midazolam (Demizolam®, Dem, Turkey), 2mcg/kg fentanyl (Talinat®, Vem, Turkey) to the patient. A field block was performed by a neurosurgeon. A 25 mcg/kg/min dose of propofol (1% Fresenius Kabi, Turkey) infusion was started to the patient. Oxygen was provided with a face mask at 2 L/min. Continuous CO2 monitoring was performed with a nasal cannula. Foreign body was removed under awake craniectomy procedure. There was a dural injury area. Dura repair was done. The craniectomy area was closed with a titanium plate. The operation took about an hour and the patient's spontaneous breathing did not disappear during this time. Vital signs remained stable. The patient's postoperative gcs was 15 and there was no neurological deficit. He was followed up in the intensive care unit overnight for control purposes. Pathological finding was not detected in the control brain tomography. The patient was taken to the ward and discharged 2 days later.
Tartışma ve Sonuç: The desired level of consciousness was achieved by propofol infusion. We concluded that the anesthesia technique was satisfactory for our patient
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