![]() Recently, a new anaesthetic, dexmedetomidine, has been introduced for this type of surgery and is considered the most effective option, not only for asleep-awake- asleep technique, but for the conscious sedation one. During exploration, the patient must be awoken slowly by removing the sedation. This procedure uses the asleep-awake-sleep anaesthetic technique, which consists of induction with propofol + sevoflurane and topical blocking with svedocain + lidocaine around the skin incision. In recent years, there has been a renewed interest in surgery in awake patients. : Anaesthetized surgery, awake surgery, cortical mapping, cortico-cortical evoked potentials, intraoperative neurophysiological monitoring. We will address in depth some technical questions about electrical stimulation whose full relevance are not always considered.įinally, we will discuss why, in the absence of empirical facts showing unequivocal superiority in post-surgical outcome, we have to awaken patients, especially when an alternate possibility exists without worst clinical results, as is the case for IONM. Finally, we will briefly discuss a promising technique to monitor some language functions in anaesthetized patients, such as cortico-cortical evoked potentials (CCEP). ![]() Later, we will discuss methods to identify and survey motor functions as motor-evoked potentials, although they are elicited trans-cranially. The main topics discussed include electrocorticography (ECoG) and cortically recorded evoked potentials (EP), including somatosensory, visual and auditory. We will review the awake technique as well as various tools used in intraoperative neurophysiological monitoring (IONM) to explore and monitor several cortical functions during long surgeries. These objectives should define the guidelines that direct clinical practice. We will discuss the aims and limitations of cortical surgery, especially the points relevant to protecting the patient. In spite of its undoubted utility for scientific research, this technique has several limitations and flaws, usually not debated by parts of the scientific community. In recent years, a renewed fashion for awake surgery has appeared. ¿Se necesita mantener despiertos a los pacientes durante una cirugía cortical? 11.1 Otros trabajos que pueden interesarleĭo we need to wake patients up during Cortical Surgery?.7.1 Intraoperative Cortico-Cortical Evoked Potentials for Monitoring Language Function.6.8 Cortico-cortical Evoked Potentials (CCEPs).6.6 Transcranial Electrical Stimulation (TES) in Subcortical Surgery.6.3 Cortical Auditory Evoked Potentials (cAEPs).6.2 Cortical Somatosensory Evoked Potentials.6 TOOLKIT FOR IONM DURING CORTICAL SURGERY IN ANAESTHETIZED PATIENTS.5 CORTICAL AND SUBCORTICAL SURGERY IN AWAKE PATIENTS.1.1 ¿Se necesita mantener despiertos a los pacientes durante una cirugía cortical?.1 Do we need to wake patients up during Cortical Surgery?.Indice: Do we need to wake patients up during Cortical Surgery?
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