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Volume 14
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10.3390/brainsci14020147
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Article

Awake Craniotomy in Conscious Sedation: The Role of A2 Agonists

by
Antonio Izzi
1,
Giuseppe Mincolelli
1,
Grazia D’Onofrio
2,*,
Vincenzo Marchello
1,
Aldo Manuali
1,
Nadia Icolaro
3,
Lucia Mirabella
4,
Anna Riefolo
5,
Barbara Mazzotta
1,
Alessio Barile
1,
Leonardo Pio Gorgoglione
3 and
Alfredo Del Gaudio
1
1
UOC of Anesthesia and Resuscitation II, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71013 Foggia, Italy
2
Health Department, Clinical Psychology Service, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71013 Foggia, Italy
3
Complex Unit of Neurosurgery, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71013 Foggia, Italy
4
Department of Medical and Surgical Science, University of Foggia, 71100 Foggia, Italy
5
Anesthesia and Intensive Care Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy
*
Author to whom correspondence should be addressed.
Brain Sci. 2024, 14(2), 147; https://doi.org/10.3390/brainsci14020147
Submission received: 22 December 2023 / Revised: 24 January 2024 / Accepted: 25 January 2024 / Published: 30 January 2024
(This article belongs to the Section Neurosurgery and Neuroanatomy)
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Abstract

Background: In Awake Craniotomy (AC), α2-agonists and remifentanil (clonidine and dexmedetomidine) are used in the preoperative phase and throughout the procedure to combine monitored anesthesia care and local anesthesia. The study aims were to specify the key role of α2-agonists administered and to evaluate complication presence/absence in anesthesiologic management. Methods: 42 patients undergoing AC in 3 different centers in the south of Italy (Foggia, San Giovanni Rotondo, and Bari) were recruited. Our protocol involves analgo-sedation by administering Dexmedetomidine and Remifentanil in continuous intravenous infusion, allowing the patient to be sedated and in comfort but contactable and spontaneously breathing. During pre-surgery, the patient is premedicated with intramuscular clonidine (2 µg/kg). In the operating setting, Dexmedetomidine in infusion and Remifentanil in Target Controlled Infusion for effect are started. At the end of the surgical procedure, the infusion of drugs was suspended. Results: There were no intraoperative side effects. The mean duration of interventions was 240 ± 62 min. The average quantity of Remifentanil and Dexmedetomidine infused during interventions were 4.2 ± 1.3 mg and 1.0 ± 0.3 mg, respectively. No significant side effects were described in the post-operative phase. A total of 86% of patients and 93% of surgeons were totally satisfied. Conclusions: Synergy between opioid drugs and α2 agonists plays a fundamental role in ensuring procedure success.
Keywords: awake craniotomy; monitored anesthesia care; α2-agonists; Dexmedetomidine; clonidine; remifrentanil awake craniotomy; monitored anesthesia care; α2-agonists; Dexmedetomidine; clonidine; remifrentanil

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MDPI and ACS Style

Izzi, A.; Mincolelli, G.; D’Onofrio, G.; Marchello, V.; Manuali, A.; Icolaro, N.; Mirabella, L.; Riefolo, A.; Mazzotta, B.; Barile, A.; et al. Awake Craniotomy in Conscious Sedation: The Role of A2 Agonists. Brain Sci. 2024, 14, 147. https://doi.org/10.3390/brainsci14020147

AMA Style

Izzi A, Mincolelli G, D’Onofrio G, Marchello V, Manuali A, Icolaro N, Mirabella L, Riefolo A, Mazzotta B, Barile A, et al. Awake Craniotomy in Conscious Sedation: The Role of A2 Agonists. Brain Sciences. 2024; 14(2):147. https://doi.org/10.3390/brainsci14020147

Chicago/Turabian Style

Izzi, Antonio, Giuseppe Mincolelli, Grazia D’Onofrio, Vincenzo Marchello, Aldo Manuali, Nadia Icolaro, Lucia Mirabella, Anna Riefolo, Barbara Mazzotta, Alessio Barile, and et al. 2024. "Awake Craniotomy in Conscious Sedation: The Role of A2 Agonists" Brain Sciences 14, no. 2: 147. https://doi.org/10.3390/brainsci14020147

APA Style

Izzi, A., Mincolelli, G., D’Onofrio, G., Marchello, V., Manuali, A., Icolaro, N., Mirabella, L., Riefolo, A., Mazzotta, B., Barile, A., Gorgoglione, L. P., & Del Gaudio, A. (2024). Awake Craniotomy in Conscious Sedation: The Role of A2 Agonists. Brain Sciences, 14(2), 147. https://doi.org/10.3390/brainsci14020147

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