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Awake Craniotomy Anaesthetic Technique — FRCA Final MCQ

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HardNeuroanaesthesiaAwake Craniotomy Anaesthetic TechniqueFRCA Final

A 50-year-old man (ASA II) is undergoing an awake craniotomy for resection of a left frontal lobe glioma near Broca's area. Which anaesthetic technique is most commonly used for the 'asleep-awake-asleep' approach?

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Correct answer: C — Dexmedetomidine infusion with scalp blocks and no airway device

The most commonly used technique for awake craniotomy currently is dexmedetomidine infusion combined with scalp nerve blocks (supraorbital, auriculotemporal, greater and lesser occipital, zygomaticotemporal). Dexmedetomidine provides cooperative sedation (patient is rousable and can perform neurological testing) without respiratory depression, making it ideal for the awake phase. Propofol/remifentanil TCI is an alternative. The 'asleep-awake-asleep' technique uses deeper sedation/GA for the initial craniotomy, wakes the patient for mapping, then re-sedates for closure.

Reference: NACCS – 2023 – Awake craniotomy guidelines; RCOA – 2023 – Neuroanaesthesia