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Year : 2018  |  Volume : 62  |  Issue : 10  |  Page : 832-833  

Concerns while monitoring patients during awake craniotomy with intraoperative magnetic resonance imaging


Department of Anaesthesiology, Tokyo Women's Medical University, Tokyo, Japan

Date of Web Publication9-Oct-2018

Correspondence Address:
Dr. Kotoe Kamata
Department of Anaesthesiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ija.IJA_521_18

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How to cite this article:
Kamata K, Ozaki M. Concerns while monitoring patients during awake craniotomy with intraoperative magnetic resonance imaging. Indian J Anaesth 2018;62:832-3

How to cite this URL:
Kamata K, Ozaki M. Concerns while monitoring patients during awake craniotomy with intraoperative magnetic resonance imaging. Indian J Anaesth [serial online] 2018 [cited 2018 Oct 20];62:832-3. Available from: http://www.ijaweb.org/text.asp?2018/62/10/832/242896



Sir,

Gandhe and Bhave suggested some important considerations for awake craniotomy under intraoperative magnetic resonance imaging (iMRI).[1] We would like to add that capnography, the concomitant monitoring of end-tidal carbon dioxide (EtCO2) and respiratory rate (RR), is essential because direct visualisation of chest movement and immediate access to the patient's airway are restricted when an awake patient is in the iMRI gantry.[2] While pulse oximetry is useful for monitoring oxygenation, desaturation lags significantly behind hypoventilation, especially when patients receive supplemental oxygen. Moreover, neurosurgical intervention may decrease the level of consciousness, which sometimes causes respiratory deterioration.[3] A review of 356 consecutive awake craniotomies at our institution revealed poor recording of the intraoperative respiratory condition of unsecured airway patients: RR was monitored in only 30.2% of all iMRI sequences (through changes in EtCO2 level), whereas oxygen saturation was recorded in 95.9% of cases.[2] While the use of capnography for non-intubated patients is still uncommon, an absolute change from baseline of greater than 10 mmHg or loss of EtCO2 waveform may indicate that the patient is at risk of significant respiratory depression.[4] All the respiratory arrests among our patients were detected based on gradually decreasing RR by capnography.[2] Careful patient observation is also important; our unwrapped draping technique enhances patient visibility [Figure 1]. Compared with high magnetic field iMRI scanners, low magnetic fields with a gap at the side of the scanner may reduce the frequency of transfer-related accidents and enable a quick response to a patient's declining status.
Figure 1: Intraoperative magnetic resonance imaging scan for the awake patient. An unwrapped draping technique in an open intraoperative magnetic resonance imaging scanner with a low field strength provides enough space for effective patient observation during scanning

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Acknowledgement

The authors would like to acknowledge Professor Yoshihiro Muragaki (Department of Neurosurgery, Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University), Professor Hiroshi Iseki (Department of Neurosurgery, Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University), Dr Takashi Maruyama (Department of Neurosurgery, Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University), Dr Taiichi Saito (Department of Neurosurgery, Tokyo Women's Medical University), and Dr Manabu Tamura (Department of Neurosurgery, Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University) for their valuable cooperation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Gandhe RU, Bhave CP. Intraoperative magnetic resonance imaging for neurosurgery – An anaesthesiologist's challenge. Indian J Anaesth 2018;62:411-7.  Back to cited text no. 1
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2.
Kamata K, Maruyama T, Iseki H, Nomura M, Muragaki Y, Ozaki M. The impact of intraoperative magnetic resonance imaging on patient safety management during awake craniotomy. J Neurosurg Anesthesiol 2017 Oct 25. doi: 10.1097/ANA.0000000000000466. [Epub ahead of print].  Back to cited text no. 2
    
3.
Kamata K, Maruyama T, Nitta M, Ozaki M, Muragaki Y, Okada Y. A case of loss of consciousness with contralateral acute subdural haematoma during awake craniotomy. J Surg Case Rep 2014 Oct 9;2014(10). pii: rju098. doi: 10.1093/jscr/rju098.  Back to cited text no. 3
    
4.
Miner JR, Biros MH, Heegaard W, Plummer D. Bispectral electroencephalographic analysis of patients undergoing procedural sedation in the emergency department. Acad Emerg Med 2003;10:638-43.  Back to cited text no. 4
    


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