Plasma ropivacaine levels during awake intracranial surgery.

Plasma ropivacaine levels produced by routine scalp infiltration for field block were assayed in eight patients undergoing awake intracranial surgery. Levels peaked within approximately 13 minutes, indicating rapid systemic absorption of ropivacaine. Potentially toxic plasma drug levels were achieved in three of eight patients, although no untoward effects attributable to elevated levels of ropivacaine were observed.

Reevaluation of surgery for the treatment of brain metastases: review of 208 patients with single or multiple brain metastases treated at one institution with modern neurosurgical techniques.

Objective: Patients with brain metastases were analyzed retrospectively to assess the risks and benefits of surgery with modern neurosurgical techniques, including image guidance coupled as indicated with corticography.

Methods: We retrospectively analyzed charts of patients treated surgically for brain metastases. We identified patients with single or multiple brain metastases who underwent craniotomies to reverse associated neurological symptoms or establish a diagnosis.

An unusual case of emergence delirium.

We present a case of postoperative delirium following endoscopic sinus surgery. We postulate a mechanism for this rare event.

Use of cuffed oropharyngeal airway (COPA) for awake intracranial surgery.

A comprehensive anesthetic plan for managing patients undergoing "awake: intracranial surgery (AICS) must include a means of rescuing the patient if the airway becomes obstructed. Since access to the patient's airway is limited, mask ventilation can be challenging and laryngoscopy and tracheal intubation, impossible. The need exists for an alternative airway device that is easy to insert, would allow controlled ventilation, and would facilitate a smooth emergence with minimal coughing.