Ammonia encephalopathy and awake craniotomy for brain language mapping: Cause of failed awake craniotomy
| Autor: | R.M. Vivanco-Hidalgo, G. Villalba Martínez, R. Arroyo Pérez, S. Pacreu Terradas, A. León Jorba, J.L. Fernández-Candil |
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| Rok vydání: | 2015 |
| Předmět: |
Male
Levetiracetam Conscious Sedation Critical Care and Intensive Care Medicine Benzodiazepines Piperidines Hyperammonemia Hypnotics and Sedatives Local anesthesia Intraoperative Complications Propofol Language Brain Diseases Brain Mapping Valproic Acid Brain Neoplasms Glioma Middle Aged Temporal Lobe Frontal Lobe Anesthesia Consciousness Disorders Anticonvulsants medicine.symptom Craniotomy medicine.drug medicine.medical_specialty Sedation Encephalopathy Remifentanil Anesthesia General Seizures Carnitine Aphasia medicine Humans Dominance Cerebral business.industry medicine.disease Piracetam Surgery Anesthesiology and Pain Medicine Clobazam Airway business Anesthesia Local |
| Zdroj: | Revista Española de Anestesiología y Reanimación. 62:275-279 |
| ISSN: | 0034-9356 |
| DOI: | 10.1016/j.redar.2014.09.009 |
| Popis: | We report the case of an aborted awake craniotomy for a left frontotemporoinsular glioma due to ammonia encephalopathy on a patient taking Levetiracetam, valproic acid and clobazam. This awake mapping surgery was scheduled as a second-stage procedure following partial resection eight days earlier under general anesthesia. We planned to perform the surgery with local anesthesia and sedation with remifentanil and propofol. After removal of the bone flap all sedation was stopped and we noticed slow mentation and excessive drowsiness prompting us to stop and control the airway and proceed with general anesthesia. There were no post-operative complications but the patient continued to exhibit bradypsychia and hand tremor. His ammonia level was found to be elevated and was treated with an infusion of l-carnitine after discontinuation of the valproic acid with vast improvement. Ammonia encephalopathy should be considered in patients treated with valproic acid and mental status changes who require an awake craniotomy with patient collaboration. |
| Databáze: | OpenAIRE |
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