Awake craniotomy for intracranial lesions: An audit of the anaesthetists’ initial experience at the University College Hospital, Ibadan

Background
Awake craniotomy (AC) is an attractive ‘minimally invasive’ anaesthetic technique for intracranial surgical procedures. There is dearth of information on the feasibility of this technique from developing countries.
Material and methods
This is a prospective descriptive study on all the patients who had AC for intracranial surgery over a 2-year period in a developing country. The data regarding their demographics, preoperative, intraoperative and postoperative anaesthetic events and any intraoperative complications were recorded.
Results
There were 18 patients, 11 (61.1%) males, mean age of 47.5 years (SD = 14.71). Propofol and Fentanyl were the sole agents providing conscious sedation during these surgical cases, while 0.25% Plain Bupivacaine and 1% Lidocaine with Adrenaline (1:200,000) were used for operative site anaesthesia. Most of the tumours, 7 (38.9%), were found in the parietal region of the brain; 9 (50.1%) patients had between 5 and 10 mm midline shift on brain MRI/CT Scan; metastatic tumours, 8 (44.4%), were the commonest lesions, and 13 (72.2%) had GCS of 15/15 prior to surgery. Hypertension and tachycardia, 3 cases (16.7%) in each, were the commonest intraoperative complications. All the patients successfully underwent the AC and none was admitted into the Intensive Care Unit postoperatively. At a mean follow-up of six months 10 (55.6%) patients were alive, 6 (33.3%) dead, and 2 (11.0%) of unknown status.
Conclusions
This audit showed AC to be a well-tolerated procedure with low rate of complications in our practice, an encouraging prospect for the feasibility of AC for intracranial surgical procedures in developing countries.