Awake craniotomy (asleep-awake-asleep technique) is performed for tumour resection in eloquent cortex. Which anaesthetic combination is ideal for the awake phase to ensure patient cooperation while providing adequate analgesia?

• A Propofol infusion continued at maintenance dose with patient stimulated periodically
• B Midazolam 5 mg IV bolus repeated as needed for patient comfort
• C Ketamine infusion for dissociative analgesia during cortical mapping
• D Dexmedetomidine infusion with local anaesthetic scalp block; allows arousable sedation without respiratory depression ✓

Explanation

Dexmedetomidine (alpha-2 agonist) provides sedation, anxiolysis, and analgesia with cooperative arousability — patients can perform language and motor tasks on command without respiratory depression. Combined with a scalp block (using local anaesthetic at pin fixation sites, temporal muscle, and supraorbital nerves), it provides excellent conditions for awake phases. Propofol at maintenance doses impairs consciousness and cooperation. Midazolam causes amnesia interfering with neurological testing. Ketamine causes dysphoria, nystagmus, and motor hyperactivity that makes cortical mapping impossible.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.