Awake craniotomy: a qualitative review and future challenges

Neurosurgery in awake patients incorporates newer technologies that require the anesthesiologists to update their skills and evolve their methodologies. They need effective communication skills and knowledge of selecting the right anesthetic drugs to ensure adequate analgesia, akinesia, along with patient satisfaction with the anesthetic conduct throughout the procedure. The challenge of providing adequate anesthetic care to an awake patient for intracranial surgery requires more than routine vigilance about anesthetic management

randomized controlled trial to compare fentanyl-propofol and ketamine-propofol combination for procedural sedation and analgesia in laparoscopic tubal ligation

Procedural sedation and analgesia is widely being used for female laparoscopic sterilization using combinations of different drugs at varying doses. This study compared the combination of fentanyl and propofol, and ketamine and propofol in patients undergoing outpatient laparoscopic tubal ligation, with respect to their hemodynamic effects, postoperative recovery characteristics, duration of hospital stay, adverse effects, and patient comfort and acceptability. Randomized, double blind. Patients were assigned to receive premixed injection of either fentanyl 1.5 micro g/kg + propofol 2 mg/kg [Group PF, n=50] or ketamine 0.5 mg/kg + propofol 2 mg/kg [Group PK, n=50]. Hemodynamic data, peripheral oxygen saturation, and respiratory rate were recorded perioperatively. Recovery time, time to discharge, and comfort score were noted. Chi-square [[2]] test was used for categorical data. Student's t-test was used for quantitative variables for comparison between the two groups. For intragroup comparison, paired t-test was used. SPSS 14.0 was used for analysis. Although the heart rate was comparable, blood pressures were consistently higher in group PK. Postoperative nausea and vomiting and delay in voiding were more frequent in group PK [P<0.05]. The time to reach Aldrete score >/= 8 was significantly longer in group PK [11.14 +/- 3.29 min in group PF vs. 17.3 +/- 6.32 min in group PK, P<0.01]. The time to discharge was significantly longer in group PK [105.8 +/- 13.07 min in group PF vs.138.18 +/- 13.20 min in group PK, P<0.01]. Patient comfort and acceptability was better in group PF, P<0.01]. As compared to ketamine-propofol, fentanyl-propofol combination is associated with faster recovery, earlier discharge, and better patient acceptability