Comparison of Subjective Patient Experiences Between Asleep-Awake-Asleep and Monitored Anesthesia Care Techniques During Awake Craniotomy.

BACKGROUND

Awake craniotomy (AC) with functional brain mapping is the standard approach for the resection of brain tumors in eloquent areas. Two main anesthetic techniques are commonly used: "Asleep-Awake-Asleep" (SAS) and "Monitored Anesthesia Care" (MAC). SAS involves general anesthesia during nonawake phases, while MAC utilizes conscious sedation, allowing for spontaneous ventilation without invasive airway devices. Both are effective and safe, but information on patient-reported intraoperative experiences is lacking. Here, we compare the subjective experience, postoperative quality of life, and operating room time of patients managed by SAS versus MAC.

METHODS

We performed a postoperative telephone survey of all consecutive patients who underwent AC for eloquent brain tumors at the University Medical Center Freiburg, Germany, between October 2018 and April 2024. SAS was used until November 2023, while MAC was used thereafter. The third part of the Beez interview protocol and the EuroQol EQ-5D-5L (including the EQ Visual Analog Scale) were delivered to assess patient-reported intraoperative experience and current health-related quality of life. Patient-reported outcomes and operating room time were compared between the 2 groups.

RESULTS

Thirty-four of 40 patients (17 in each group) were available for telephone interview with more female patients in the SAS group compared with the MAC group (82% vs. 12%, P <0.001). Other baseline parameters were balanced. Patient-reported intraoperative experience and quality of life were similar between the SAS and MAC groups. Operating room times were significantly shorter for MAC (366±107 min) than for SAS (453±81 min) ( P =0.011).

CONCLUSIONS

Our institutional protocols for SAS and MAC resulted in similar intraoperative experience and postoperative QoL, while MAC procedures had shorter operating room times. Larger studies are required to confirm these findings.