Total intravenous anaesthesia (TIVA) is preferred over volatile agent-based anaesthesia for awake craniotomy. Which SPECIFIC intraoperative period requires the patient to be awake and cooperative in this procedure?

• A Scalp incision and bone flap removal
• B Dural closure and wound repair
• C Cortical mapping with direct electrical stimulation to identify eloquent cortex ✓
• D Induction and airway management

Explanation

Awake craniotomy uses an 'asleep-awake-asleep' or 'awake' sedation technique specifically to allow intraoperative neurological testing. The patient must be conscious and cooperative during cortical mapping (direct electrocortical stimulation), during which the neurosurgeon identifies eloquent areas (motor strip, speech areas, sensory cortex) to be preserved. This is performed under local/regional scalp block with sedation for the surgical phases, while the patient speaks, moves limbs or performs language tasks during mapping. The scalp incision and bony work are performed under deep sedation.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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