OBJECTIVE: We evaluated a combined technique designed for procedures r
equiring intraoperative language mapping. We planned to induce general
anesthesia with endotracheal intubation and hyperventilation and then
to awaken and extubate the patient for speech testing. After the latt
er, endotracheal reintubation and general anesthesia were planned. MET
HODS: With the patient under intravenously induced sedation, we topica
lly anesthetized the airway with lidocaine that was delivered through
a spraying catheter. Fiberoptic endotracheal intubation was then perfo
rmed on the awake patient, using a modified endotracheal tube. General
anesthesia with intravenous propofol or sodium thiopental was induced
, the patient's head was attached to a Mayfield holder, and the pin an
d operative sites were infiltrated with 0.5% bupivacaine with epinephr
ine. In anticipation of speech mapping, general anesthesia was discont
inued and lidocaine was injected into the catheter that was spirally a
ttached to the endotracheal tube. After speech mapping, the awake pati
ents were endotracheally intubated, guided with the fiberoptic laryngo
scope or tube changer, and general anesthesia was induced and maintain
ed until termination of the surgery. RESULTS: We did not observe any c
omplications, such as coughing or head movements, during the preparati
on for general anesthesia, awakening and endotracheal extubation for s
peech mapping, and post-testing reintubation or induction of general a
nesthesia. CONCLUSION: The combined technique that we describe abolish
ed the potential discomfort of surgical stimulation on a sedated patie
nt, reduced the duration of wakefulness, and provided a secure airway
and the means to hyperventilate our patients before dural opening.