viernes, 28 de abril de 2017

Craniotomía con paciente despierto / Awake craniotomy

Abril 25, 2017. No. 2670

Craniotomía con paciente despierto utilizando dexmedetomidina, propofol y remifentanil
Awake craniotomy anesthetic management using dexmedetomidine, propofol, and remifentanil.
Drug Des Devel Ther. 2017 Mar 3;11:593-598. doi: 10.2147/DDDT.S124736. eCollection 2017.
INTRODUCTION: Awake craniotomy allows continuous monitoring of patients' neurological functions during open surgery. Anesthesiologists have to sedate patients in a way so that they are compliant throughout the whole surgical procedure, nevertheless maintaining adequate analgesia and anxiolysis. Currently, the use of α2-receptor agonist dexmedetomidine as the primary hypnotic-sedative medication is increasing. METHODS: Nine patients undergoing awake craniotomy were treated with refined monitored anesthesia care (MAC) protocol consisting of a combination of local anesthesia without scalp block, low-dose infusion of dexmedetomidine, propofol, and remifentanil, without the need of airways management. RESULTS: The anesthetic protocol applied in our study has the advantage of decreasing the dose of each drug and thus reducing the occurrence of side effects. All patients had smooth and rapid awakenings. The brain remained relaxed during the entire procedure. CONCLUSION: In our experience, this protocol is safe and effective during awake brain surgery. Nevertheless, prospective randomized trials are necessary to confirm the optimal anesthetic technique to be used.
KEYWORDS: anesthesia; awake surgery; dexmedetomidine

Craniotomía con paciente despierto. Una revisión cualitativa y desafíos futuros.
Awake craniotomy: A qualitative review and future challenges.
Saudi J Anaesth. 2014 Oct;8(4):529-39. doi: 10.4103/1658-354X.140890.
Neurosurgery in awake patients incorporates newer technologies that require the anesthesiologists to update their skills and evolve their methodologies. They need effective communication skills and knowledge of selecting the right anesthetic drugs to ensure adequate analgesia, akinesia, along with patient satisfaction with the anesthetic conduct throughout the procedure. The challenge of providing adequate anesthetic care to an awake patient for intracranial surgery requires more than routine vigilance about anestheticmanagement.
KEYWORDS: Awake craniotomy; neuroanesthesiology

Anestesia para craneotomía en el paciente despierto: una actualización
Jason Chui
Rev Colomb Anestesiol 2 0 1 5;43(S1):22-28
La craneotomía en el paciente despierto se ha generalizado y su aplicación ha evolucionado continuamente. La anestesia para este procedimiento plantea un reto singular para los anestesiólogos. Los objetivos de este artículo son revisar, bajo la perspectiva crítica del autor, la evidencia actual y la aplicación de la craneotomía en el paciente despierto, y describir brevemente los principios del manejo anestésico durante el procedimiento.

Foro Internacional de Medicina Crítica
Ciudad de México, Julio 13-15, 2017
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