• Nelson Davi Bolzani, Daisy de Oliveira Pollon Junqueira, Paulo André Pinheiro Fernandes Ferrari, Antonio Fernandes Ferrari, Felipe Gaia, Caroline Moraes Tapajós, José Francisco Cursino de Moura Junior, and Edmundo Pereira de Souza Neto.
• Anesthesiology Team of Presidente Prudente, Hospital Regional de Presidente Prudente, São Paulo, SP, Brazil.
• Braz J Anesthesiol. 2013 Nov 1;63(6):500-3.

Background And ObjectivesSome intracranial procedures are achievable with patients awake, however, there are challenges ranging from patient compliance to homeostasis. The aim of this study is to present a case of intracranial surgery for removal of a tumor in the left parietal lobe with the patient awake during the procedure.Case ReportAfter patient selection and psychological preparation, the proposed excision of the left parietal lobe lesion in the waking state was clarified and accepted. Continuous infusion of propofol and remifentanil was administered to maintain a Ramsay score of 2-3. The bilateral scalp blockade was performed with ropivacaine. The Mayfield head fixation device was installed and drapes adjusted to maintain the airway and eyes accessible for mapping with electrical stimulation and tumor excision. For dura mater incision, a pad with 2% lidocaine was applied for 3 minutes. The surgery was uneventful. The patient was discharged on the seventh day of hospitalization without presenting complication.ConclusionAlthough the maintenance of analgesia and hemodynamic stability was a challenge with the patient awake, the target-controlled infusion of propofol provided the desired level of consciousness, remifentanil titrated analgesia and sedation without drug accumulation, and the blockade with ropivacaine provided satisfactory analgesia. We conclude that the anesthetic technique was satisfactory for our patient.Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

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