Craniotomies

[deleted875186]

Curious how people do their craniotomies? Do most people use TIVA, or volatile with opioids? Are most people using remifentanyl or something else? Do you give any long acting opioids before waking up? Anyone doing any awake craniotomies?

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[Lecithin5]

Usually tiva with prop/remi (prop/sufenta if rlly long case). Once awake, I start working in long acting opioid (assuming remi use). I’ve had good success with precedex plus low dose remi infusion for awake crani

 

[anbuitachi]

Propofol to lower metabolic Cmo2/cbf. Volatiles increase Cbf so i prefer propofol over that. Remi infusion for steady high dose of narcotics so they dont move while not paralyzed, and low dose remi for smoother wakeup.

 

[leaverus]

With neuromonitoring or pt with significant ICP: Prop/remi vs sufenta ("TIVA", i'll sometimes crack the volatile a whiff because I think that smooths out the anesthetic a bit without affecting signals)

No NM: Whatever

If i'm running remi, I usually start working in longer act narc during closure