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Background and Aims The goal of case report is the management of awake craniotomy with sleep-awake-awake tecnique. An awake craniotomy is a surgical procedure in which patient is deliberately kept awake during whole surgical process or a portion of surgery.
Methods The patient was a 49-year-old male; MRI revealed a 42x38 mm glial tumor in the temporal region, close to Broca area, in the structures of the neurosurgery clinic with a complaint of headache. A craniotomy with scalp block was planned for the patient. Consent was obtained after preoperative information was given. Standard anesthesia monitoring(ASA) was performed on the patient. We planned the sleep-awake-awake technique in awake craniotomy. In induction, 2.5mg/kg of propofol, 1.5mcg/kg of fentanyl and 1mg/kg of lidocaine were administered. A supraglottic airway device, I-gel, is inserted. Then, scalp block was performed with 0.5% bupivacaine. Neurosurgeon applied Mayfield pine. As neurosurgeon approached where the tumor was located, the stage of awakening the birth was started. Before these steps, a loading dose of dexmedetomidine 1mcg/kg was given as a 15-minute infusion in 100cc fluid, and 0.2mcg/kg/hour was switched to maintenance. Remifentanil and sevoflurane are reduced and turned off after 15minutes. The patient whose spontaneous breathing started was awakened, and i-gel laryngeal mask was removed. The patient was talked to every 3-5 minutes until the tumor area was reached and controlled by starting the engine. The patient would talk long enough to answer the questions.
Results Awake craniotomy is multidisciplinary teamwork, and the anesthesiologist should know for various purposes, scalp blockage, and forward referral management.