Omfort, while the preoperative preparation was rated adequate in 94.9 . Other studies support these findings with postoperative satisfaction rates of 96.5 up to 100 [20,44,47,52,60]. Degree of satisfaction measured by visual analogue scale (VAS) in one study [56], which compared propofol-based to dexmedetomidine-based SAS protocol, showed a high degree of satisfaction (VAS 92) in both patient groups. In contrast, the blinded surgeons`satisfaction was significantly higher in the dexmedetomidine group. Careful patient-positioning is a further crucial factor influencing the success of AC, due to patient comfort and compliance [21]. Active participation of the patients in the positioning phase supported probably the high patient satisfaction (84 ) in a further study [27]. Avoidance of PONV is another contributing factor for patient satisfaction after AC. Beside this, PONV bears the risk of dehydration and in case of vomiting it could increase critically the intracranial pressure [70]. Incidence of Nausea within 24h after craniotomy in GA technique was reported with 30?0 [70], favouring the use of antiemetic prophylaxis. Fabling et al. showed a significant reduction of PONV by AZD-8055MedChemExpress AZD-8055 prophylaxis with low dose droperidol orPLOS ONE | DOI:10.1371/journal.pone.0156448 May 26,36 /Anaesthesia Management for Awake Craniotomyondansetron in their RCT [70]. Nausea was analysed intraoperatively in eleven of our included studies [17,18,20,27,30,36,44,51,54,56,59], and postoperatively in ten studies [17,18,30,33,45,46,50,51,54,58]. The intra- and postoperative incidences showed a range between 0 [18,30,46,51,59] and 30 [45,46]. The effect of antiemetic prophylaxis could not be evaluated for all of these studies, as it was not reported entirely. Ouyang et al. used ondansetron as well as dexamethasone and had a similar incidence of 30 as previously reported for patients receiving ondansetron [70]. Interestingly, preoperative midline shift of averagely 5.96mm did not enhance the risk for PONV [45], although it is an independent risk factor for intraoperative brain oedema. The tumour histopathology was also not associated with an increased incidence of PONV [46]. Usefulness of BIS, or equal monitoring of anaesthesia depth, remains debatable in patients with neurological disorders, or antiepileptic drug therapy. While one report a strong delay in actual BIS values and awareness in AC patients with lower values than 80 [71], others recommend its use for AC [72]. However, in our review there was no difference between the occurrence of AC failures in studies, which did not use any objective anaesthesia depth control [10,18?2,24,25,27?9,32,34?8,40?4,47,49?2,54,55,60,61] compared to studies, which used either RE or BIS monitoring [23,26,33,39,48,53,56,58,59,62]. Favourable evidence for using BIS in SAS was shown in one study, where the patients recovered faster if the BIS values were targeted to higher levels before Vesatolimod price commence of the awake phase [26]. Another study with MAC anaesthesia showed significantly reduced propofol and fentanyl dosages in patients with BIS monitoring compared to patients without [58]. This could have an impact on the success of awake surgery tasks. The influence of prior sedation on the cognitive and motoric ability to perform intraoperative tasks [73]. Reduction of propofol dosage was also the aim in a further of our included studies [48]. Interestingly, they used the volatile anaesthetic sevoflurane until the dura opening for this purpose.Omfort, while the preoperative preparation was rated adequate in 94.9 . Other studies support these findings with postoperative satisfaction rates of 96.5 up to 100 [20,44,47,52,60]. Degree of satisfaction measured by visual analogue scale (VAS) in one study [56], which compared propofol-based to dexmedetomidine-based SAS protocol, showed a high degree of satisfaction (VAS 92) in both patient groups. In contrast, the blinded surgeons`satisfaction was significantly higher in the dexmedetomidine group. Careful patient-positioning is a further crucial factor influencing the success of AC, due to patient comfort and compliance [21]. Active participation of the patients in the positioning phase supported probably the high patient satisfaction (84 ) in a further study [27]. Avoidance of PONV is another contributing factor for patient satisfaction after AC. Beside this, PONV bears the risk of dehydration and in case of vomiting it could increase critically the intracranial pressure [70]. Incidence of Nausea within 24h after craniotomy in GA technique was reported with 30?0 [70], favouring the use of antiemetic prophylaxis. Fabling et al. showed a significant reduction of PONV by prophylaxis with low dose droperidol orPLOS ONE | DOI:10.1371/journal.pone.0156448 May 26,36 /Anaesthesia Management for Awake Craniotomyondansetron in their RCT [70]. Nausea was analysed intraoperatively in eleven of our included studies [17,18,20,27,30,36,44,51,54,56,59], and postoperatively in ten studies [17,18,30,33,45,46,50,51,54,58]. The intra- and postoperative incidences showed a range between 0 [18,30,46,51,59] and 30 [45,46]. The effect of antiemetic prophylaxis could not be evaluated for all of these studies, as it was not reported entirely. Ouyang et al. used ondansetron as well as dexamethasone and had a similar incidence of 30 as previously reported for patients receiving ondansetron [70]. Interestingly, preoperative midline shift of averagely 5.96mm did not enhance the risk for PONV [45], although it is an independent risk factor for intraoperative brain oedema. The tumour histopathology was also not associated with an increased incidence of PONV [46]. Usefulness of BIS, or equal monitoring of anaesthesia depth, remains debatable in patients with neurological disorders, or antiepileptic drug therapy. While one report a strong delay in actual BIS values and awareness in AC patients with lower values than 80 [71], others recommend its use for AC [72]. However, in our review there was no difference between the occurrence of AC failures in studies, which did not use any objective anaesthesia depth control [10,18?2,24,25,27?9,32,34?8,40?4,47,49?2,54,55,60,61] compared to studies, which used either RE or BIS monitoring [23,26,33,39,48,53,56,58,59,62]. Favourable evidence for using BIS in SAS was shown in one study, where the patients recovered faster if the BIS values were targeted to higher levels before commence of the awake phase [26]. Another study with MAC anaesthesia showed significantly reduced propofol and fentanyl dosages in patients with BIS monitoring compared to patients without [58]. This could have an impact on the success of awake surgery tasks. The influence of prior sedation on the cognitive and motoric ability to perform intraoperative tasks [73]. Reduction of propofol dosage was also the aim in a further of our included studies [48]. Interestingly, they used the volatile anaesthetic sevoflurane until the dura opening for this purpose.
