Awake Craniotomy Without Invasive Blood Pressure Monitoring

Document Type


Publication Date



Neurology and Neuroscience, Surgery

Journal Title

World neurosurgery


OBJECTIVE: The aim of this study was to assess the safety of foregoing invasive monitoring in a select group of patients undergoing awake craniotomy for supratentorial tumor resection. METHODS: Awake craniotomies were performed for tumor resection without invasive BP monitoring when there was no pre-existing cardiopulmonary indication as determined by the attending anesthesiologist according to institutional protocol. Non-invasive monitoring was performed every 3-5 minutes intraoperatively and then every 15 minutes in the recovery room for 4 hours before transfer to the ward. RESULTS: Seventy-four consecutive awake surgeries were performed with non-invasive BP monitoring at a single tertiary care hospital. 42 (83.8%) had infiltrative primary brain tumors, 39 (52.7%) were male, 2 (2.7%) had history of coronary artery disease, 6 (8.1%) were diabetics and 10 (29.7%) were smokers. 22 of the 74 (29.7%) patients were on antihypertensive medications preoperatively. American Society of Anesthesiologists (ASA) classification was I in 1.4%, II in 36.4%, III in 60.8% and IV in 1.4%. Twenty-one (28.4%) received intraoperative vasoactive medications and eight (38%) of these were on antihypertensive agents preoperatively. Of these 21, thirteen (61.9%) received vasodilators, six (28.6%) received vasopressors and two (9.5%) were dosed with both vasodilators and vasopressors. One patient had a lenticulostriate artery stroke intraoperatively and one patient had atrial fibrillation one week postoperatively. There were no other perioperative anesthetic, hemorrhagic, renal or cardiopulmonary complications. CONCLUSIONS: Intraoperative physiologic control and surgical site complication avoidance do not warrant routine invasive BP monitoring during awake craniotomy for tumor resection.


Russell Kizor, MBBS- Resident