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Abstract
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Background and Aims Awake craniotomy is most commonly preferred in tumor resections that may cause neurological sequelae, arteriovenous malformation surgery, and deep brain stimulation applications such as Parkinson’s disease. This case report describes an awake craniotomy performed with a monitored anesthesia care method in a high-risk patient with severe COVID-19 pneumonia.
Methods A 61-year-old male patient with known hypertension, diabetes, and coronary artery disease was isolated at home and diagnosed with SARS-CoV2 infection. The patient had a subdural hematoma due to head trauma as a result of sudden loss of consciousness (figure-1). He was unconscious (GCS:10 points). Due to his hypoxic condition and severe pneumonia (figure-2), operation was considered high-risk, and awake craniotomy was planned. He had respiratory rate of 46/min; heart rate of 88/min; blood pressure of 160/69mmHg, and oxygen saturation 86% with 4lt/min oxygen. Initially, a loading dose of dexmedetomidine was given as 1mcg/kg/100cc IV infusions for 15 minutes. Then, invasive blood pressure monitoring and bilateral scalp block with 0.5% bupivacaine were performed. The patient was sedated with dexmedetomidine infusion until end of operation. The operation, without any complications, was completed in 40 minutes.
Preoperative patient‘s brain tomography axial section image
Preoperative patient‘s lung tomography axial section image
Results Scalp block takes first place in craniotomy analgesia and also provides hemodynamic stability. It is known that dexmedetomidine is an excellent alternative to propofol for sedoanalgesia. Therefore, the main reason for preferring the awake craniotomy method is that the patient has severe pneumonia.
Conclusions Awake craniotomy requires multidisciplinary teamwork and personal experience. Dexmedetomidine remains an indispensable agent of awake craniotomy with its anxiolytic and analgesic properties and minimal respiratory depression effect.