Awake Craniotomy Without Invasive Blood Pressure Monitoring
Neurology and Neuroscience, Surgery
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.
Florman JE, Rughani AI, Kizor R, Pardi G, England E, Brown E. Awake Craniotomy Without Invasive Blood Pressure Monitoring [published online ahead of print, 2022 Oct 8]. World Neurosurg. 2022;S1878-8750(22)01427-9. doi:10.1016/j.wneu.2022.10.021