1. Comparison of the Asleep-Awake-Asleep Technique and Monitored Anesthesia Care During Awake Craniotomy: A Systematic Review and Meta-analysis
- Author
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Lara Prisco, Massimo Antonelli, Tatjana Petrinic, Karina Fitzgibbon, Ruben Rosenkranz, Mario Ganau, and Daniele Natalini
- Subjects
Adult ,Nausea ,Operative Time ,asleep-awake-asleep ,awake craniotomy ,epilepsy neurosurgery ,monitored anesthesia care ,neuroanesthesia ,neurooncological surgery ,Lower risk ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,030202 anesthesiology ,law ,Settore MED/41 - ANESTESIOLOGIA ,Humans ,Medicine ,Anesthesia ,Wakefulness ,Monitoring, Physiologic ,Brain Neoplasms ,business.industry ,Incidence (epidemiology) ,Odds ratio ,Confidence interval ,Anesthesiology and Pain Medicine ,Pooled variance ,Meta-analysis ,Surgery ,Neurology (clinical) ,medicine.symptom ,business ,Craniotomy ,030217 neurology & neurosurgery - Abstract
Awake craniotomy (AC) is the preferred surgical option for intractable epilepsy and resection of tumors adjacent to or within eloquent cortical areas. Monitored anesthesia care (MAC) or an asleep-awake-asleep (SAS) technique is most widely used during AC. We used a random-effects modeled meta-analysis to synthesize the most recent evidence to determine whether MAC or SAS is safer and more effective for AC. We included randomized controlled trials and observational studies that explored the incidence of AC failure, duration of surgery, and hospital length of stay in adult patients undergoing AC. Eighteen studies were included in the final analysis. MAC was associated with a lower risk of AC failure when compared with SAS (global pooled proportion MAC vs. SAS 1% vs. 4%; odds ratio [ORs]: 0.28; 95% confidence interval [CI]: 0.11-0.71; P=0.007) and shorter surgical procedure time (global pooled mean MAC vs. SAS 224.44 vs. 327.94 min; mean difference, -48.76 min; 95% CI: -61.55 to -35.97; P
- Published
- 2020
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