Brain tumor surgery with an awake patient, experience in a regional hospital

Objective: To describe the experience of three patients who underwent craniotomy for tumor resection under the awake-awake-awake modality and to develop an anesthetic intervention scheme with medications available at the institutional level, to keep patients with a sufficient level of consciousness to allow interaction during the transoperative period.

Methods: We present the case of three patients who underwent craniotomy and tumor resection under the awake-awake-awake modality. Non-invasive monitoring and blocking of the scalp and surgical area were used.

Results: Three male patients with intracerebral tumors underwent surgery, extensive resection of the lesions was achieved, the patients did not require invasive airway management, and they adequately went through the planned stages of the procedure. All patients were referred to the recovery service conscious and oriented, with stable vital signs. The process for using medications and the available resources were optimized with a proposed anesthetic protocol.

Conclusion: the awake-awake-awake technique allows the patient to remain more comfortable and cooperative during the stages of surgery, the adequate blocking of the scalp leads to less drug use and better responses. The technique used and the medication protocol developed allow the procedure to be performed without the need to secure the airway in the first and last phases. It is possible to perform neurosurgical interventions with an awake patient in hospitals in rural areas of Costa Rica.