BoardsBridgeSupratentorial Tumor — Anesthesia Technique for Craniotomy
Propofol-fentanyl advantage, dexamethasone for mass effect, and when to go awake
Anesthesia for supratentorial tumor craniotomy hinges on (1) preop dexamethasone 10 mg for tumor-related mass effect/edema, (2) a predominantly IV technique until the cranium and dura are open in patients with raised-ICP signs, and (3) propofol-fentanyl over volatile-fentanyl to minimize subdural pressure and AVDO2.
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Propofol-fentanyl beats isoflurane/sevoflurane-fentanyl in tumor patients
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Key numbers
- Dexamethasone 10 mg IV/PO preop; 48-hr course is ideal, 24 hr sufficient for clinical effect
- Fentanyl mean ~26 mcg/kg induced electrical seizure activity in 8/9 patients with partial-complex seizures undergoing anterior temporal lobectomy
- Alfentanil 50 mcg/kg augmented temporal-lobe spike activity in epilepsy patients
- Remifentanil 0.07 ± 0.03 mcg/kg/min preserved CPP better than propofol 4.3 ± 2.5 mg/kg/h in stereotactic biopsy
- Alfentanil 40 mcg/kg produced no significant ICP change in hydrocephalic children
Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: Millers Anesthesia 10 Ch53 Anesthesia FOR Neurologic Surgery AND Neurointerventions · Millers Anesthesia 10 Ch10 Cerebral Physiology AND THE Effects OF Anesthetic · Millers Anesthesia 10 Ch22 Opioids · Millers Anesthesia 10 Ch35 Neurophysiologic Monitoring
Re-review cadence: 12 months from reviewed date.
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Card ID: supratentorial-tumor · Path: aba.neuro.intracranial.supratentorial-tumor