REMIFENTANIL AND PROPOFOL COMBINATION FOR AWAKE CRANIOTOMY - CASE-REPORT WITH PHARMACOKINETIC SIMULATIONS

Remifentanil and propofol infusions were used to provide neuroleptanal gesia during an awake craniotomy to resect a left frontoparietal gliob lastoma near the motor speech center. This operation presented anesthe tic requirements ranging from adequate analgesia during bone flap remo val to an appropriate level of consciousness during cortical speech ma pping. We performed pharmacokinetic simulations to estimate the effect site concentrations of propofol and remifentanil as the infusion rate s were modulated to meet the dynamic sedation and analgesic needs of t he operation. Simulations revealed that changes in infusion rates were quickly followed by changes in the effect site concentrations which c orresponded well with the desired changes in patient sedation and anal gesia. We propose that remifentanil and propofol in combination may be a useful technique for awake craniotomy.