PROPOFOL SEDATION DURING AWAKE CRANIOTOMY FOR SEIZURES - PATIENT-CONTROLLED ADMINISTRATION VERSUS NEUROLEPT ANALGESIA

This prospective study evaluated the safety and efficacy of patient-co ntrolled sedation (PCS) using propofol during awake seizure surgery pe rformed under bupivacaine scalp blocks. Thirty-seven patients were ran domized to receive either propofol PCS combined with a basal infusion of propofol (n = 20) or neurolept analgesia using an initial bolus dos e of fentanyl and droperidol followed by a fentanyl infusion (n = 17). Both groups received supplemental fentanyl and dimenhydrinate for int raoperative pain and nausea, respectively. Comparisons were made betwe en groups for sedation, memory, and cognitive function, patient satisf action, and incidence of complications. Levels of intraoperative sedat ion and patient satisfaction were similar between groups. Memory and c ognitive function were well preserved in both groups. The incidence of transient episodes of ventilatory rate depression (<8 bpm) was more f requent among the propofol patients (5 vs 0, P = 0.04), particularly a fter supplemental doses of opioid. Intraoperative seizures were more c ommon among the neurolept patients (7 vs 0, P = 0.002). PCS using prop ofol represents an effective alternative to neurolept analgesia during awake seizure surgery performed in a monitored care environment.