Anaesthesia in Craniotomy Surgery with Full Wakefulness: A Case Report

Introduction: Some intracranial surgeries must be performed while the patient is awake.Awake craniotomy is an intracranial surgical procedure in which the patient remains in a state of controlled consciousness while the surgery is performed.The aim of this study was to present a case of intracranial surgery to remove a tumor in the right frontal cortex using awake craniotomy.Case Report: This report describes the anesthetic management of a 22-year-old male undergoing craniotomy with a fully awake technique.This was the first case of craniotomy performed entirely awake (from the beginning to the end of the operation) at Arak University of Medical Sciences and Valiasr Hospital in Arak, After preoperative preparation and evaluation, scalp nerve blocks targeting the cranial nerves innervating the scalp and head muscles were administered at specific sites.Mild sedation was provided using oxygen supplementation, followed by surgical incision.The lesion was examined intraoperatively while the patient remained awake, and the tumor was safely excised under full wakefulness.A combination of local and regional anesthesia and light intravenous sedation was utilized.Two types of local anesthetics, lidocaine 1.5% and bupivacaine 2.5%, were used for anesthesia, as well as intravenous sedatives and anesthetics such as propofol, remifentanil, and dexmedetomidine were administered for sedation.Throughout the operation, the patient was awake and breathing spontaneously, and the function of the brain nerves during the operation could be evaluated.Finally, the patient's surgery was performed without any complications and in stable condition, and the patient was transferred to the intensive care unit in good general condition, awake and fully alert.Conclusions: Although maintaining analgesia and hemodynamic and adequate ventilation during fully awake craniotomy poses challenges, this technique is critical for intraoperative monitoring of cranial nerve function and preventing neurological deficits.By precisely administering scalp nerve blocks and carefully titrating sedatives (propofol, remifentanil, dexmedetomidine), we successfully performed the procedure under full wakefulness.With this method, potential surgical complications are prevented, and the patient also experiences satisfactory painlessness.Applying this technique was satisfactory for our patient.