Pausing propofol during neurosurgery to record intraoperative electrocorticography is feasible;10 years of clinical experience

• Propofol administration can be paused to increase signal quality of ioECoG tailored epilepsy surgery. • In our cohort of > 350 surgeries signs of inadequate sedation depth after temporarily pausing propofol administration were rare. • Propofol administration was paused up to 30 min, though long pause durations were likely to induce hemodynamic changes. Intraoperative electrocorticography (ioECoG) during neurosurgery is influenced by anesthetics. In our center we stop the propofol to enable interpretation of ioECoG. We reported our clinical experience and evaluated awareness and hemodynamic changes during the propofol-free periods (PFP). We retrospectively included surgeries with paused propofol administration to record ioECoG (period: 2008–2019). Clinical reports were screened for symptoms of awareness. We compared mean arterial blood pressure (MAP; mmHg) and heart rate (HR;bpm) during PFP to baseline (ten minutes preceding PFP). An increase > 15% was defined as clinically relevant. The association between hemodynamic changes and clinical characteristics was analyzed using logistic regression models. Propofol administration was paused 742 times in 352 surgeries (mean PFP duration 9 ± 5 min). No signs of awareness were reported. MAP and HR increased > 15% in 54 and six PFPs. Five PFPs showed both MAP and HR increases. Prolonged PFP was associated with having MAP and HR increase during surgery (OR=1.18, 95%CI [1.12–1.26]). Signs of inadequate sedation depth were rare. MAP and HR increases were related to the length of PFP. We summarize 10 years of clinical experience with pausing propofol administration during epilepsy surgery to record ioECoG without evidence of awareness.