'Anesthesia' for awake neurosurgery

Purpose of review In this review we focus on recent findings in the anesthetic management of patients undergoing craniotomy while awake, and propose a structured approach to the clinical practice of 'anesthesia' for awake neurosurgery. Recent findings The increasing use of functional neurosurgery and recent evidence favoring resection of tumor involving eloquent cortex has expanded the indications for awake craniotomy, a procedure needing a fully cooperative patient and expert intraoperative anesthetic management. Despite the shorter hospital stay, the more recently published studies have highlighted perioperative anesthetic complications and have proposed ways to improve anesthesia techniques for awake procedures in adults and children. Summary Although anesthesia for awake craniotomy is usually a well tolerated procedure it requires an extensive knowledge of the principles underlying neuroanesthesia and of specific technical strategies including local anesthesia for scalp blockade, advanced airway management, dedicated sedation protocols, and skillful management of hemodynamics.