- Discuss positioning and type of intraoperative mapping (ie, motor versus language) with surgeon.
- Ensure comfortable positioning and adequate access to the patient's airway.
- Standard monitors are used. Invasive monitoring is indicated in patients with significant comorbidity, at risk for major blood loss and/or when reliable blood pressure cannot be obtained, especially in lateral positions.
- Administer supplemental oxygen, with means of monitoring of end tidal CO2 and respiratory rate.
- Avoid urinary catheter unless the duration of surgery is >4 hours and/or mannitol will be administered.
- Ensure adequate local anesthesia for pin sites, scalp and incision, with scalp blocks or field infiltration.
- Surgical drapes should form a tent around the patient's face to allow access to the airway and communication with the patient.
- For conscious sedation, commonly used anesthetic agents include propofol, midazolam, fentanyl, remifentanil, and dexmedetomidine.
- For an asleep-awake-asleep technique, commonly used strategies include intravenous induction, airway management with a supraglottic airway, and maintenance of anesthesia with total intravenous anesthesia (eg, propofol and remifentanil) or inhalation anesthesia (eg, sevoflurane).
- Maintain vigilance for complications (eg, seizures, respiratory adverse events, nausea and vomiting, lack of patient cooperation) and institute rapid treatment.
|
