Propofol-remifentanil anesthesia for tumor surgery with cortical and subcortical mapping: A retrospective study on 37 patients

Valeria Conte, P. Baratta, V. Songa, E. Fava, L. Bello, N. Stocchetti

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Abstract

Background: the anesthetic approach during functional brain mapping for tumor surgery should allow language and motor testing while providing adequate analgesia and sedation. Objectives: to describe drug dosing, level of hypnosis and anesthetic complications in patients undergoing tumor resection with functional brain mapping. Methods: total intravenous anesthesia was performed with remifentanil/propofol infusion. Ojemann cortical stimulator, electrocorticography (EcoG), EEG and EMG monitoring were used. Patients were divided into two groups: group 1 (G1) was awaken and laryngeal mask airway removed to allow language testing during cortical and subcortical stimulation; group 2 (G2) (motor testing only) was anesthetized but not paralyzed and ventilation was supported via naso-tracheal intubation throughout the procedure. BIS index monitoring was used to control hypnotic levels. Results: we retrospectively studied 37 patients admitted between July 2005 and June 2006 for tumor resection. The procedure lasted 369±61 min in G1 (n = 25, Male 15, age 40, 53-22 yrs) and 346±65 min in G2 (n = 12, Male 5, age 51, 76-23 yrs). During cortical and subcortical stimulation, G1 patients were fully awake, remifentanil was infused at 0.042±0.022 microg/kg/min, median BIS index was 85 (range 98-75), systolic arterial pressure (SAP) was 142±15 mmHg. Hypertensive crises occurred in 3 patients but rapidly resolved after β-blockers administration. Cortical and subcortical brain mapping was possible in G2 with the infusion of remifentanil at 0.074±0.023 microg/kg/min and propofol at 4.6±2.6 mg/kg/h, while median BIS index was 48 (range 20-65) and SAP was 121±19 mmHg (p <0.05 vs G1). Acceptable correspondence was found between EcoG, EEG and BIS monitoring. Seizures occurred in both groups (G1: 8/25, G2: 7/12) but mainly resolved within 1 minute after cold saline irrigation; only 4 patients required drug administration during brain mapping. Conclusions: remifentanil/propofol infusion grants adequate sedation, analgesia and haemodynamic control while allowing functional testing during cortical and subcortical stimulation.

Original languageEnglish
Pages (from-to)11-14
Number of pages4
JournalRivista Medica
Volume12
Issue number1-2
Publication statusPublished - Mar 2006

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Propofol
Brain Mapping
Anesthesia
Retrospective Studies
Neoplasms
Anesthetic Hypnosis
Analgesia
Electroencephalography
Arterial Pressure
Language
Blood Pressure
Intravenous Anesthesia
Laryngeal Masks
Organized Financing
Hypnotics and Sedatives
Intubation
Brain Neoplasms
Pharmaceutical Preparations
Ventilation
Anesthetics

Keywords

  • Awake surgery
  • Bispectral index
  • Total intravenous anesthesia

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{747a4cf4f0bf46319e78d04df8523d7d,
title = "Propofol-remifentanil anesthesia for tumor surgery with cortical and subcortical mapping: A retrospective study on 37 patients",
abstract = "Background: the anesthetic approach during functional brain mapping for tumor surgery should allow language and motor testing while providing adequate analgesia and sedation. Objectives: to describe drug dosing, level of hypnosis and anesthetic complications in patients undergoing tumor resection with functional brain mapping. Methods: total intravenous anesthesia was performed with remifentanil/propofol infusion. Ojemann cortical stimulator, electrocorticography (EcoG), EEG and EMG monitoring were used. Patients were divided into two groups: group 1 (G1) was awaken and laryngeal mask airway removed to allow language testing during cortical and subcortical stimulation; group 2 (G2) (motor testing only) was anesthetized but not paralyzed and ventilation was supported via naso-tracheal intubation throughout the procedure. BIS index monitoring was used to control hypnotic levels. Results: we retrospectively studied 37 patients admitted between July 2005 and June 2006 for tumor resection. The procedure lasted 369±61 min in G1 (n = 25, Male 15, age 40, 53-22 yrs) and 346±65 min in G2 (n = 12, Male 5, age 51, 76-23 yrs). During cortical and subcortical stimulation, G1 patients were fully awake, remifentanil was infused at 0.042±0.022 microg/kg/min, median BIS index was 85 (range 98-75), systolic arterial pressure (SAP) was 142±15 mmHg. Hypertensive crises occurred in 3 patients but rapidly resolved after β-blockers administration. Cortical and subcortical brain mapping was possible in G2 with the infusion of remifentanil at 0.074±0.023 microg/kg/min and propofol at 4.6±2.6 mg/kg/h, while median BIS index was 48 (range 20-65) and SAP was 121±19 mmHg (p <0.05 vs G1). Acceptable correspondence was found between EcoG, EEG and BIS monitoring. Seizures occurred in both groups (G1: 8/25, G2: 7/12) but mainly resolved within 1 minute after cold saline irrigation; only 4 patients required drug administration during brain mapping. Conclusions: remifentanil/propofol infusion grants adequate sedation, analgesia and haemodynamic control while allowing functional testing during cortical and subcortical stimulation.",
keywords = "Awake surgery, Bispectral index, Total intravenous anesthesia",
author = "Valeria Conte and P. Baratta and V. Songa and E. Fava and L. Bello and N. Stocchetti",
year = "2006",
month = "3",
language = "English",
volume = "12",
pages = "11--14",
journal = "Rivista Medica",
issn = "1127-6339",
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TY - JOUR

T1 - Propofol-remifentanil anesthesia for tumor surgery with cortical and subcortical mapping

T2 - A retrospective study on 37 patients

AU - Conte, Valeria

AU - Baratta, P.

AU - Songa, V.

AU - Fava, E.

AU - Bello, L.

AU - Stocchetti, N.

PY - 2006/3

Y1 - 2006/3

N2 - Background: the anesthetic approach during functional brain mapping for tumor surgery should allow language and motor testing while providing adequate analgesia and sedation. Objectives: to describe drug dosing, level of hypnosis and anesthetic complications in patients undergoing tumor resection with functional brain mapping. Methods: total intravenous anesthesia was performed with remifentanil/propofol infusion. Ojemann cortical stimulator, electrocorticography (EcoG), EEG and EMG monitoring were used. Patients were divided into two groups: group 1 (G1) was awaken and laryngeal mask airway removed to allow language testing during cortical and subcortical stimulation; group 2 (G2) (motor testing only) was anesthetized but not paralyzed and ventilation was supported via naso-tracheal intubation throughout the procedure. BIS index monitoring was used to control hypnotic levels. Results: we retrospectively studied 37 patients admitted between July 2005 and June 2006 for tumor resection. The procedure lasted 369±61 min in G1 (n = 25, Male 15, age 40, 53-22 yrs) and 346±65 min in G2 (n = 12, Male 5, age 51, 76-23 yrs). During cortical and subcortical stimulation, G1 patients were fully awake, remifentanil was infused at 0.042±0.022 microg/kg/min, median BIS index was 85 (range 98-75), systolic arterial pressure (SAP) was 142±15 mmHg. Hypertensive crises occurred in 3 patients but rapidly resolved after β-blockers administration. Cortical and subcortical brain mapping was possible in G2 with the infusion of remifentanil at 0.074±0.023 microg/kg/min and propofol at 4.6±2.6 mg/kg/h, while median BIS index was 48 (range 20-65) and SAP was 121±19 mmHg (p <0.05 vs G1). Acceptable correspondence was found between EcoG, EEG and BIS monitoring. Seizures occurred in both groups (G1: 8/25, G2: 7/12) but mainly resolved within 1 minute after cold saline irrigation; only 4 patients required drug administration during brain mapping. Conclusions: remifentanil/propofol infusion grants adequate sedation, analgesia and haemodynamic control while allowing functional testing during cortical and subcortical stimulation.

AB - Background: the anesthetic approach during functional brain mapping for tumor surgery should allow language and motor testing while providing adequate analgesia and sedation. Objectives: to describe drug dosing, level of hypnosis and anesthetic complications in patients undergoing tumor resection with functional brain mapping. Methods: total intravenous anesthesia was performed with remifentanil/propofol infusion. Ojemann cortical stimulator, electrocorticography (EcoG), EEG and EMG monitoring were used. Patients were divided into two groups: group 1 (G1) was awaken and laryngeal mask airway removed to allow language testing during cortical and subcortical stimulation; group 2 (G2) (motor testing only) was anesthetized but not paralyzed and ventilation was supported via naso-tracheal intubation throughout the procedure. BIS index monitoring was used to control hypnotic levels. Results: we retrospectively studied 37 patients admitted between July 2005 and June 2006 for tumor resection. The procedure lasted 369±61 min in G1 (n = 25, Male 15, age 40, 53-22 yrs) and 346±65 min in G2 (n = 12, Male 5, age 51, 76-23 yrs). During cortical and subcortical stimulation, G1 patients were fully awake, remifentanil was infused at 0.042±0.022 microg/kg/min, median BIS index was 85 (range 98-75), systolic arterial pressure (SAP) was 142±15 mmHg. Hypertensive crises occurred in 3 patients but rapidly resolved after β-blockers administration. Cortical and subcortical brain mapping was possible in G2 with the infusion of remifentanil at 0.074±0.023 microg/kg/min and propofol at 4.6±2.6 mg/kg/h, while median BIS index was 48 (range 20-65) and SAP was 121±19 mmHg (p <0.05 vs G1). Acceptable correspondence was found between EcoG, EEG and BIS monitoring. Seizures occurred in both groups (G1: 8/25, G2: 7/12) but mainly resolved within 1 minute after cold saline irrigation; only 4 patients required drug administration during brain mapping. Conclusions: remifentanil/propofol infusion grants adequate sedation, analgesia and haemodynamic control while allowing functional testing during cortical and subcortical stimulation.

KW - Awake surgery

KW - Bispectral index

KW - Total intravenous anesthesia

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