[Anesthesiological care in removal of bulky formations from functionally important hemispheric zones: craniotomy in conscious state].

A method of anesthesia allowing patient's awakening to the level of verbal contact after trephination and opening of the dura mater was used in 37 patients with bulky formations (33 patients with tumors and 4 with arteriovenous malformations) in the speech zones of speech-dominant hemisphere. Speech mapping of the brain, carried out in alert patients, helped eliminate permanent speech deficiency during the postoperative period in all patients. The protocol of anesthesia was as follows: locoregional anesthesia of soft tissues of the head with a mixture of 2% xylocaine and 0.5% marcaine with epinephrine intravenous diprivan at stages requiring no patient's alertness, clopheline, fractionated midazolam (after identification of speech zones). The study showed that this protocol helps solve the problem and adequately protects the organism from surgical stress, provides good conditions for manipulations on the brain, involves no unpleasant sensations for the patient, and in 70% patients helps attain complete amnesia of the perioperative period. The most severe complication is an epileptic attack. Respiratory monitoring (pulse oximetry and capnography in the lateral duct) is obligatory for preventing respiratory disorders in patients on spontaneous respiration who were not intubated.