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Intraoperative panic attack in patients undergoing awake craniotomy: a retrospective analysis of risk factors

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Abstract

Purpose

Intraoperative anxiety is the most common psychological response of the patient during awake craniotomy. Psychological stress can trigger patient decline, resulting in failed awake craniotomy and significantly poor outcomes. This study aimed to identify the risk factors for panic attack (PA) during awake craniotomies.

Methods

With the local ethics committee approval, we conducted a manual chart review of the medical record of patients who underwent consecutive awake craniotomies between November 1999 and October 2016 at Tokyo Women's Medical University. A total of 405 patients were identified and assigned to 2 groups based on the Diagnostic and Statistical Manual of Mental Disorders-V criteria: those that met the PA criteria (Group PA) and those that did not (Group non-PA). Patient characteristics and the incidence of the PA specifier were collected. The features of the two groups were statistically compared, and risk factors for PA occurrence were determined by regression analysis.

Results

Sixteen of 405 patients met the diagnostic criteria of PA. Patients' characteristics were not statistically different between the groups. Multivariate logistic regression showed that intraoperative anxiety (p = 0.0002) and age younger than 39 years (as opposed to age >  = 39 years; p = 0.0328) were significantly associated with the occurrence of PA during awake craniotomy.

Conclusions

For patients undergoing awake craniotomy, intraoperative anxiety and age younger than 39 years were considered risk factors of PA. As PA often necessitates conversion to general anesthesia, intensive perioperative psychological support and pain management are required to achieve patient satisfaction and the surgical goal of awake craniotomy.

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References

  1. Dziedzic T, Bernstein M. Awake craniotomy for brain tumor: indications, technique and benefits. Expert Rev Neurother. 2014;14:1405–15.

    Article  CAS  Google Scholar 

  2. Meng L, McDonagh DL, Berger MS, Gelb AW. Anesthesia for awake craniotomy: a how-to guide for the occasional practitioner. Can J Anaesth. 2017;64:517–29.

    Article  Google Scholar 

  3. 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. Tolerance of awake craniotomy for glioma: a prospective European low grade glioma network multicenter study. Acta Neurochir (Wien). 2013;155:1301–8.

    Article  Google Scholar 

  4. Santini B, Talacchi A, Casagrande F, Casartelli M, Savazzi S, Procaccio F, Gerosa M. Eligibility criteria and psychological profiles in patient candidates for awake craniotomy: a pilot study. J Neurosurg Anesthesiol. 2012;24:209–16.

    Article  Google Scholar 

  5. Potters JW, Klimek M. Awake craniotomy: improving the patient’s experience. Curr Opin Anaesthesiol. 2015;28:511–6.

    Article  Google Scholar 

  6. Eseonu CI, ReFaey K, Garcia O, John A, Quiñones-Hinojosa A, Tripathi P. Awake craniotomy anesthesia: a comparison of the monitored anesthesia care and asleep-awake-asleep techniques. World Neurosurg. 2017;104:679–86.

    Article  Google Scholar 

  7. Milian M, Tatagiba M, Feigl GC. Patient response to awake craniotomy—a summary overview. Acta Neurochir (Wien). 2014;156:1063–70.

    Article  Google Scholar 

  8. Klimek M, van der Horst PH, Hoeks SE, Stolker RJ. Quality and quantity of memories in patients who undergo awake brain tumor resection. World Neurosurg. 2018;109:e258–64.

    Article  Google Scholar 

  9. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013. p. 208–17.

    Book  Google Scholar 

  10. Roy-Byrne PP, Craske MG, Stein MB. Panic disorder. Lancet. 2006;368:1023–32.

    Article  Google Scholar 

  11. Hervey-Jumper SL, Li J, Lau D, Molinaro AM, Perry DW, Meng L, Berger MS. Awake craniotomy to maximize glioma resection: methods and technical nuances over a 27-year period. J Neurosurg. 2015;123:325–39.

    Article  Google Scholar 

  12. Garavaglia MM, Das S, Cusimano MD, Crescini C, Mazer CD, Hare GMT, Rigamonti A. Anesthetic approach to high-risk patients and prolonged awake craniotomy using dexmedetomidine and scalp block. J Neurosurg Anesthesiol. 2014;26:226–33.

    Article  Google Scholar 

  13. Hejrati N, Spieler D, Samuel R, Regli L, Weyerbrock A, Surbeck W. Conscious experience and psychological consequences of awake craniotomy. World Neurosurg. 2019;129:e381–6.

    Article  Google Scholar 

  14. Kayama T, Guidelines committee of the Japan awake surgery conference. The guidelines for awake craniotomy. Neurol Med Chir (Tokyo). 2012;52:119–41.

    Article  Google Scholar 

  15. 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. 2019;31:62–9.

    Article  Google Scholar 

  16. Muragaki Y, Chernov M, Yoshimitsu K, Suzuki T, Iseki H, Maruyama T, Tamura M, Ikuta S, Nitta M, Watanabe A, Saito T, Okamoto J, Niki C, Hayashi M, Takakura K. Information-guided surgery of intracranial gliomas: overview of an advanced intraoperative technology. J Healthc Eng. 2012;3:551–70.

    Article  Google Scholar 

  17. Muragaki Y, Iseki H, Maruyama T, Chernov M, Suzuki T, Yoshimitsu K, Tamura M, Ikuta S, Nitta M, Okamoto J, Takakura K. Advanced surgical management of gliomas: technological requirements, concept of information-guided resection, and clinical results. In: Abujamra AL, editor. Diagnostic techniques and surgical management of brain tumors. London: InTech Open Limited; 2011. p. 517–34.

    Google Scholar 

  18. Muragaki Y, Iseki H, Maruyama T, Kawamata T, Yamane F, Nakamura R, Kubo O, Takakura K, Hori T. Usefulness of intraoperative magnetic resonance imaging for glioma surgery. Acta Neurochir Suppl. 2006;98:67–75.

    Article  CAS  Google Scholar 

  19. Muragaki Y, Iseki H, Maruyama T, Tanaka M, Shinohara C, Suzuki T, Yoshimitsu K, Ikuta S, Hayashi M, Chernov M, Hori T, Okada Y, Takakura K. Information-guided surgical management of gliomas using low-field-strength intraoperative MRI. Acta Neurochir Suppl. 2011;109:67–72.

    Article  Google Scholar 

  20. Nossek E, Matot I, Shahar T, Barzilai O, Rapoport Y, Gonen T, Sela G, Korn A, Hayat D, Ram Z. Failed awake craniotomy: a retrospective analysis in 424 patients undergoing craniotomy for brain tumor. J Neurosurg. 2013;118:243–9.

    Article  Google Scholar 

  21. Stevanovic A, Rossaint R, Veldeman M, Bilotta F, Coburn M. Anaesthesia management for awake craniotomy: systematic review and meta-analysis. PLoS ONE. 2016;11: e0156448.

    Article  Google Scholar 

  22. Shiraki A, Goto W, Fukagawa H, Arakawa Y, Kikuchi T, Mineharu Y, Yamao Y, Yasuda T, Hattori E, Fukui A, Matsui Y, Yonezawa A, Furukawa K, Mizota T. Effects of low-dose remifentanil infusion on analgesic or antiemetic requirement during grain function mapping: a retrospective cohort study. Acta Anaesthesiol Scand. 2020;64:735–41.

    Article  CAS  Google Scholar 

  23. Fontaine D, Almairac F. Pain during awake craniotomy for brain tumor resection. Incidence, causes, consequences and management. Neurochirurgie. 2017;63:204–7.

    Article  CAS  Google Scholar 

  24. Kessler RC, Petukhova M, Sampson NA, Zaslavsky AM, Wittchen HU. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res. 2012;21:169–84.

    Article  Google Scholar 

  25. Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S. The prevalence of psychological distress by cancer site. Psychooncology. 2001;10:19–28.

    Article  CAS  Google Scholar 

  26. Goebel S, Stark AM, Kaup L, von Harscher M, Mehdorn HM. Distress in patients with newly diagnosed brain tumours. Psychooncology. 2011;20:623–30.

    Article  CAS  Google Scholar 

  27. Zemmoura I, Fournier E, El-Hage W, Jolly V, Destrieux C, Velut S. Hypnosis for awake surgery of low-grade gliomas: description of the method and psychological assessment. Neurosurgery. 2016;78:53–61.

    Article  Google Scholar 

  28. Joswig H, Bratelj D, Brunner T, Jacomet A, Hildebrandt G, Surbeck W. Awake craniotomy: first-year experiences and patient perception. World Neurosurg. 2016;90:588–96.

    Article  Google Scholar 

  29. Goebel S, Nabavi A, Schubert S, Mehdorn HM. Patient perception of combined awake brain tumor surgery and intraoperative 1.5-T magnetic resonance imaging: the Kiel experience. Neurosurgery. 2010;67:594–600.

    Article  Google Scholar 

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Acknowledgements

Dr. Takashi Maruyama helped to design the study and to write the manuscript. Dr. Ryu Komatsu helped to interpret the data and provided valuable expertise in writing the manuscript. Dr. Makoto Ozaki helped to design the study and helped to write the manuscript. The authors would like to acknowledge Dr. Yoko Uchiide (Certified psychiatrist) for giving a wide range of views in the psychiatric field. The authors are also indebted to Dr. Satoru Shimizu (School of Arts and Sciences, Tokyo Woman's Christian University) for his expert advice about statistical analysis. The authors would also like to acknowledge Dr. Yoshihiro Muragaki (Department of Neurosurgery, Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University), Dr. Takakazu Kawamata (Department of Neurosurgery, Tokyo Women's Medical University), Dr. Masayuki Nitta (Department of Neurosurgery, Tokyo Women's Medical University), Dr. Taiichi Saito (Department of Neurosurgery, Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, 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.

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Authors and Affiliations

  1. Department of Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai-shi, Miyagi, 980-8575, Japan

    Kotoe Kamata

  2. Department of Anesthesiology, Tokyo Women’s Medical University, Tokyo, Japan

    Kotoe Kamata & Makoto Ozaki

  3. Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan

    Takashi Maruyama

  4. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA

    Ryu Komatsu

  5. Department of Primary Care Medicine, Nishiarai Hospital, Tokyo, Japan

    Makoto Ozaki

Authors
  1. Kotoe Kamata
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  2. Takashi Maruyama
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Corresponding author

Correspondence to Kotoe Kamata.

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Conflict of interest

The authors report no financial interests or potential conflicts of interest. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Preliminary data for this study, which the local ethics committee approved of Tokyo Women's Medical University on November 1, 2016 (No. 4141; Chairperson Prof. Toshimasa Yoshioka), was previously presented as a poster presentation at the Euroanaesthesia 2017 Annual Meeting, 3–5 June 2017, Geneva, Switzerland.

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Kamata, K., Maruyama, T., Komatsu, R. et al. Intraoperative panic attack in patients undergoing awake craniotomy: a retrospective analysis of risk factors. J Anesth 35, 854–861 (2021). https://doi.org/10.1007/s00540-021-02990-0

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  • DOI: https://doi.org/10.1007/s00540-021-02990-0

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