THE ASLEEP-AWAKE-ASLEEP ANESTHETIC TECHNIQUE FOR INTRAOPERATIVE LANGUAGE MAPPING

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.