PDF(Pubmed)
Abstract：
Awake craniotomy (AC) is sometimes aborted due to poor arousal and restlessness. Dexmedetomidine (DEX), an α2-adrenoreceptor agonist, has sedative, analgesic, and anesthetic-sparing effects, with a low risk of respiratory depression, making it effective for intraoperative pain and agitation during the awake phase. We report a case in which AC was successfully performed in combination with low-dose continuous administration of DEX during reoperation in a patient who experienced poor arousal and restlessness during their first surgery, leading to the abandonment of AC. The patient is a 48-year-old male who is scheduled for AC reoperation. Two years ago, the first AC was scheduled and performed under anesthesia with propofol and remifentanil. However, AC was abandoned due to poor intraoperative arousal and restlessness. At reoperation, general anesthesia was induced with propofol and continuous administration of remifentanil (0.1 µg/kg/min); following anesthesia induction (continuous infusion of propofol, remifentanil, and a bolus infusion of fentanyl), DEX was also administered (0.2 µg/kg/hour). We performed a scalp nerve block. Before the awake phase, the propofol dose was decreased as was DEX to 0.1 µg/kg/hour, and propofol and remifentanil were discontinued. The patient gradually awoke without any agitation and restlessness 24 min after stopping propofol and remifentanil and could perform language tasks without any complications. In this case, AC was successfully performed in combination with continuous low-dose administration of DEX at the time of reoperation in a patient who experienced poor arousal and restlessness during their first operation and had to discontinue AC.
摘要：
清醒开颅术（AC）有时会由于苏醒和躁动而中止。右美托咪定（DEX），α2-肾上腺素受体激动剂,有镇静剂,镇痛药,和麻醉效果，呼吸抑制的风险很低，使其在清醒阶段对术中疼痛和躁动有效。我们报告了一例患者在第一次手术中经历了不良的觉醒和躁动的患者，在再次手术期间，AC与低剂量的DEX连续给药联合成功进行。导致放弃AC。患者是一名48岁的男性，计划进行AC再手术。两年前,首次AC在丙泊酚和瑞芬太尼麻醉下进行.然而,由于术中唤醒和躁动不良，放弃了AC。再次手术时,全身麻醉用丙泊酚诱导，并连续给予瑞芬太尼（0.1µg/kg/min）；麻醉诱导后（连续输注丙泊酚，瑞芬太尼,和芬太尼的大剂量输注)，还给予DEX(0.2μg/kg/小时)。我们做了头皮神经阻滞。在清醒阶段之前，丙泊酚剂量减少，DEX减少到0.1微克/千克/小时，停用异丙酚和瑞芬太尼.停用异丙酚和瑞芬太尼后24分钟，患者逐渐苏醒，没有任何躁动和躁动，并且可以执行语言任务而没有任何并发症。在这种情况下,在再次手术时，AC与DEX的连续低剂量给药联合成功地进行了治疗，该患者在首次手术中表现出不良的唤醒和躁动，不得不停止AC。
