Anesthesia for same day neurosurgery with updates on awake craniotomy and awake spine surgery.

PURPOSE OF REVIEW: This article delves into recent advances in same-day neurosurgery (SDNS), specifically concerning indications, perioperative protocol, safety, and outcomes. Additionally, it explores the recent updates on awake craniotomy and awake spine surgery.

RECENT FINDINGS: There is an evolving body of literature on studies about SDNS that reaffirm its safety and feasibility. awake craniotomy is associated with lesser neurological deficits and better survival benefits in patients with lesions in eloquent areas. Monitored anesthesia care, compared with the asleep-awake-asleep technique, is associated with lower failure rates, shorter procedure time, and shorter length of stay. However, the incidence of intraoperative seizures is lower with the asleep-awake-asleep technique. Propofol-based and dexmedetomidine-based anesthesia are similar with regard to procedure duration, intraoperative adverse events, and patient satisfaction; however, surgeon satisfaction is higher with dexmedetomidine-based anesthesia. In spine surgery, regional anesthesia when compared with general anesthesia, is associated with less intraoperative blood loss and a lower incidence of postoperative nausea and vomiting after 24 h. In addition, implementing an enhanced multimodal analgesia protocol improved disability scores and reduced the likelihood of postoperative complications.

SUMMARY: SDNS offers promising prospects for patients and healthcare providers alike, with the potential to provide well tolerated, efficient, and cost-effective neurosurgical care in carefully selected cases.