Awake Cranioplasty: A Case Series

Background: Cranioplasty restores the normal cranial architecture and protective functions of the skull and may play a role in normalizing cerebrospinal fluid dynamics in patients undergoing large craniectomies. It has a definitive impact on restoration of normal intracranial physiology and improvement of patient neurological condition. Anesthesia for awake neurosurgery procedure poses a unique challenge to anesthesiologists. Objective: To present cases of awake cranioplasty and describe the principles of anesthetic management during this procedure. Case description: 3 patients who have skull defect underwent cranioplasty procedure. Patients were managed with dexmedetomidine load of 1 mcg/kg over 10-15 min followed by infusion at rates of 0.2 mcg/kg/hr to 0.7 mcg/kg/hr and a local infiltration without airway instrumentation. Discussion: Awake cranioplasty offers great advantages with respect to patient outcome. In this type of procedure, the anesthesiologist’s goal is to make the operation safe and effective and reduce the psychophysical distress of the patient. Personal experience, careful planning, and attention to detail are the basis for obtaining good awake cranioplasty results. Dexmedetomidine is a highly specific α2 adrenoceptor agonist with sedative, analgesic, anesthetic sparing effect, awake if neither stimulated brain protection with no addiction effect nor suppress ventilation. Patients treated with dexmedetomidine will be sedated, comfortably but is easily aroused. Conclusion: Awake cranioplasty procedures were successfully performed with stable hemodynamic intraoperative and no complications during procedure. Dexmedetomidine has been shown to provide sedation and analgesia without significant respiratory depression and has been used successfully in these settings.