Laryngeal mask airway in awake craniotomies for cortical language mapping

Abstract

In order to determine the eloquent cortical areas responsible for speech, motor, primary sensory, or visual cortex the patient must be conscious and able to talk during cortical stimulation. The challenge for the anesthetist is to find a technique which provides adequate sedation, analgesia, and respiratory and hemodynamic control, but also an awake and cooperative patient for neurological testing. Although a craniotomy can be performed under local anesthesia, the patient will better tolerate the procedure if removal of the bone flap is performed under general anesthesia. We reported our experience with four adult patients who underwent cranial surgery concerning the dominant hemisphere. These patients had an asleep-awake-asleep technique. During asleep phase, lungs were ventilated with 50 % N2O in O2 via laryngeal mask airway and infusion of propofol and alfentanil was done. During awake cortical mapping, alfentanil infusion was continued and oxygenation was maintained via a nasal cannula. We concluded that the use of laryngeal mask airway together with propofol-alfentanil anesthesia may be an alternative technique for conscious cortical stimulation mapping procedures.