PROPOFOL SEDATION DURING AWAKE CRANIOTOMY FOR SEIZURES - ELECTROCORTICOGRAPHIC AND EPILEPTOGENIC EFFECTS

This prospective study evaluated the effects of propofol sedation on t he incidence of intraoperative seizures and the adequacy of electrocor ticographic (ECoG) recordings during awake craniotomy performed for th e management of refractory epilepsy. Thirty patients scheduled for tem poral or frontal lobectomy for epilepsy under bupivacaine scalp block were randomized to receive patient-controlled propofol sedation (PCS) combined with a basal infusion of propofol (rr = 15) or neurolept anal gesia using an initial bolus dose of fentanyl (0.7 mu g/kg) and droper idol (0.04 mg/kg) followed by a fentanyl infusion (n = 15). Propofol a dministration was suspended 15 min before ECoG recording in the PCS gr oup. The occurrence of inappropriate intraoperative seizures was noted and, based on blind review, the adequacy of ECoG recordings was compa red. A higher incidence of intraoperative seizures was noted among the neurolept patients (6 vs 0, P = 0.008). Intraoperatively, ECoG record ings were adequate to proceed with resection in both groups. Evidence of low spike activity on ECoG did not correlate with the type of sedat ion administered. Higher frequency background ECoG activity was noted among patients who received propofol, but this did not interfere with ECoG interpretation. The use of propofol sedation does not appear to i nterfere with ECoG during epilepsy surgery, provided administration is suspended at least 15 min before recording.