Advertisement

Acta Neurochirurgica

, Volume 156, Issue 8, pp 1491–1492 | Cite as

The usefulness of the awake-awake-awake technique

  • Christian Doenitz
  • Alexander Brawanski
  • Ernil Hansen
Letter to the editor - Brain Tumors

Dear Sirs,

We appreciate the comments from Dr. Duffau [3] on our paper “Awake craniotomies without any sedation: the awake-awake-awake technique” [5].

We agree that an awake patient is the best candidate for intraoperative neurological testing, and it is obvious that the less the patient is mentally compromised by sedatives, the better the test results will be. Thus, in a recent publication we could demonstrate that patients show unimpaired alertness with our procedure, whereas higher cognitive functions were compromised for at least an hour in other patients with intermittent anesthesia or sedation with propofol [6].

We fully agree that during the purely surgical phases the patient should not follow this in the sense of focusing on the surgical procedure. Duffau here suggests the use of sedation in accordance with the common asleep-awake-asleep technique. As the sedatives and anesthetics in question are also called “hypnotics”, it is justified to ask if only a pharmacological...

Keywords

Astrocytoma Delay Testing High Cognitive Function Emotional Feeling Neurological Testing 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflicts of interest

None.

References

  1. 1.
    Beez T, Boge K, Wager M, Whittle I, Fontaine D, Spena G, Braun S, Szelényi A, Bello L, Duffau H, Sabel M, European Low Grade Glioma Network (2013) Tolerance of awake surgery for glioma: a prospective European low grade glioma network multicenter study. Acta Neurochir (Wien) 155(7):1301–1308CrossRefGoogle Scholar
  2. 2.
    Cheek DB (1962) Importance of recognizing that surgical patients behave as though hypnotized. Am J Clin Hypn 4:227–231PubMedCrossRefGoogle Scholar
  3. 3.
    Duffau H (2013) The reliability of asleep-awake-asleep protocol for intraoperative functional mapping and cognitive monitoring in glioma surgery. Acta Neurochir (Wien) 155:1803–1804CrossRefGoogle Scholar
  4. 4.
    Faymonville M-E, Bejenke CJ, Hansen E (2010) Hypnotic techniques. In: Cyna A, Andrew MI, Tan SGM, Smith AF (eds) Handbook of communication in anaesthesia and critical care, chap. 20. Oxford University Press, Oxford, pp 249–261Google Scholar
  5. 5.
    Hansen E, Seemann M, Zech N, Doenitz C, Luerding R, Brawanski A (2013) Awake craniotomies without any sedation: the awake-awake-awake technique. Acta Neurochir (Wien) 155:1417–1424CrossRefGoogle Scholar
  6. 6.
    Ott C, Kerscher C, Luerding R, Doenitz C, Hoehne J, Zech N, Seemann M, Schlaier J, Brawanski A (2014) The impact of sedation on brain mapping: a prospective, interdisciplinary clinical trial. Neurosurgery DOI:  10.1227/NEU.0000000000000359
  7. 7.
    Ruffmann C, Bogliun G, Beghi E (2006) Epileptogenic drugs: a systematic review. Expert Rev Neurother 6(4):575–589PubMedCrossRefGoogle Scholar
  8. 8.
    Szelényi A, Joksimovic B, Seifert V (2007) Intraoperative risk of seizures associated with transient direct cortical stimulation in patients with symptomatic epilepsy. J Clin Neurophysiol 24(1):39–43PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2014

Authors and Affiliations

  • Christian Doenitz
    • 1
  • Alexander Brawanski
    • 1
  • Ernil Hansen
    • 2
  1. 1.Department of NeurosurgeryUniversity Hospital RegensburgRegensburgGermany
  2. 2.Department of AnesthesiologyUniversity Hospital RegensburgRegensburgGermany

Personalised recommendations