| Title |
Awake craniotomy using dexmedetomidine and scalp blocks: a retrospective cohort study
|
|---|---|
| Published in |
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, July 2018
|
| DOI | 10.1007/s12630-018-1178-z |
| Pubmed ID | |
| Authors |
Niamh McAuliffe, Stuart Nicholson, Andrea Rigamonti, Gregory M. T. Hare, Michael Cusimano, Marco Garavaglia, Iryna Pshonyak, Sunit Das |
| Abstract |
Anesthetic and surgical considerations for awake craniotomy (AC) include airway patency, patient comfort, and optimization of real-time brain mapping. The purpose of this study is to report our experience of using dexmedetomidine and scalp blocks, without airway intervention, as a means to facilitate and optimize intraoperative brain mapping and brain tumour resection during AC. We conducted a retrospective cohort study of 55 patients who underwent AC from March 2012 to September 2016. The incidence of critical airway outcomes, perioperative complications, and successful intraoperative mapping was determined. The primary outcome was the incidence of a failed AC anesthetic technique as defined by the need to convert to general anesthesia with a secured airway prior to (or during) brain mapping and brain tumour resection. Secondary outcomes were the intraoperative incidence of: 1) altered surgical management due to information acquired through real-time brain mapping, 2) interventions to restore airway patency or rescue the airway, 3) hemodynamic instability (> 20% from baseline), 4) nausea and vomiting, 5) new onset neurologic deficits, and 6) seizure activity. There were no anesthesia-related critical events and no patients required airway manipulation or conversion to a general anesthetic. Multimodal language, motor, and sensory assessment with direct cortical electrical stimulation was successfully performed in 100% of cases. In 24% (13/55) of patients, data acquired during intraoperative brain mapping influenced surgical decision-making regarding the extent of tumour resection. Nine (16%) patients had intraoperative seizures. Dexmedetomidine-based anesthesia and scalp block facilitated AC surgery without any requirement for urgent airway intervention or unplanned conversion to a full general anesthetic. This approach can enable physiologic testing before and during tumour resection facilitating real-time surgical decision-making based on intraoperative brain mapping with patients awake thereby minimizing the risk of neurologic deficit and increasing the opportunity for optimal surgical resection. |
X Demographics
The data shown below were collected from the profiles of 19 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Canada | 4 | 21% |
| Costa Rica | 1 | 5% |
| Saudi Arabia | 1 | 5% |
| United States | 1 | 5% |
| Unknown | 12 | 63% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 16 | 84% |
| Scientists | 1 | 5% |
| Practitioners (doctors, other healthcare professionals) | 1 | 5% |
| Science communicators (journalists, bloggers, editors) | 1 | 5% |
Mendeley readers
The data shown below were compiled from readership statistics for 78 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 78 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Bachelor | 11 | 14% |
| Student > Master | 9 | 12% |
| Student > Postgraduate | 6 | 8% |
| Student > Doctoral Student | 6 | 8% |
| Other | 5 | 6% |
| Other | 14 | 18% |
| Unknown | 27 | 35% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 28 | 36% |
| Engineering | 6 | 8% |
| Neuroscience | 5 | 6% |
| Nursing and Health Professions | 4 | 5% |
| Psychology | 1 | 1% |
| Other | 5 | 6% |
| Unknown | 29 | 37% |
Attention Score in Context
This research output has an Altmetric Attention Score of 10. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 11 May 2019.
All research outputs
#3,548,563
of 25,459,177 outputs
Outputs from Canadian Journal of Anesthesia/Journal canadien d'anesthésie
#560
of 2,882 outputs
Outputs of similar age
#66,674
of 341,055 outputs
Outputs of similar age from Canadian Journal of Anesthesia/Journal canadien d'anesthésie
#13
of 38 outputs
Altmetric has tracked 25,459,177 research outputs across all sources so far. Compared to these this one has done well and is in the 86th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 2,882 research outputs from this source. They typically receive more attention than average, with a mean Attention Score of 9.6. This one has done well, scoring higher than 80% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 341,055 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 80% of its contemporaries.
We're also able to compare this research output to 38 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 65% of its contemporaries.