Target-controlled infusion of propofol and remifentanil combined with bispectral index monitoring for awake craniotomy

We describe the target-controlled administration of propofol and remifentan il, combined with monitoring of the bispectral index, during an awake crani otomy for removal of a left temporoparietal tumour near the motor speech ce ntre. Target concentrations of the two drugs were adjusted according to the patient's responses to painful stimuli and surgical events, and the need f or speech testing. Allowing the effect-site concentrations of propofol and remifentanil to decrease during surgery allowed the performance of cortical speech mapping and the testing of the patient's ability to speak. Although the bispectral index was not used as a guide for the administration of the drugs, its Value correlated better with the patient's responsiveness than did the predicted effect-site concentrations of propofol. Side-effects, com prising hypotension, respiratory depression and airway obstruction, were re lated to rapid increases in drug infusion rates and were easily managed.