Awake Craniotomy

Prior to the advent of anesthesia, performing surgical procedures on patients in the awake state was the order of the day. In modern times, especially with the continued advancement and safety of anesthesia, such a practice of performing surgery on a patient in the awake state might appear unnecessary, and perhaps even medieval. However, this practice still does intentionally occur for a subset of neurosurgery patients. This unique dimension of the procedure places special demands on the anesthesiologist’s knowledge base, skill and training in order to produce a successful patient outcome. This chapter delves into salient aspects of patient selection, operating room setup, monitoring and communication considerations, pharmacologic regimens, regional anesthetic options and a thorough list of complications for which to be prepared. This review contains 5 figures, 5 tables, and 69 references. Keywords: awake craniotomy, functional neurosurgery, eloquent cortex, awake-asleep-awake, electrocorticography, epilepsy, deep brain stimulator, dexmedetomidine, intraoperative seizure