Abstract:

Objective To explore individualized anesthesia management for patients undergoing epileptogenic foci resection and decrease the effects of narcotics and anesthetic management on electrocorticography(ECoG) monitoring during epilepsy surgery and to study the awake testing during general anesthesia(GA) and anesthesia management for electrophysiological stimulation of cortex during the operation. Methods The data of 127 patients undergoing epilepsy surgery from 20052007 were reviewed and analyzed. The patients were divided into 3 groups: Group A(GA), Group B(GA+awake testing) and Group C(local anesthesia+intravenous anesthesia) with 105,16,and 6 patients, respectively. In Group A, propofol,remifentanil and vecuronium were infused continuously with(2.69±0.48)mg/(kg·h^-1), (0.09±0.02)μg/(kg·min^-1) and (0.05±0.06)mg/(kg·h^-1) respectively after intubation. And some inhaled 0.4%~0.6% isoflurane to maintain anesthesia. The infusion doses of propofol and remifentanil were increased in Group B, not using isoflurane. In group C, patients received scalp nerve block with 0.5% lidocaine mixed with 0.25% ropivacaine, and continuous infusion of propofol and remifentanil with 1~2 mg/(kg·h^-1) and 0.03~0.05 μg/(kg·min^-1). Results Both group A and B stopped infusing 15 minutes before ECoG. 94.8% of patients could be detected abnormal brain waves in ECoG 15~30 minutes later in Group A; 100% patients in group B waked up quickly when infusion was stopped, but complained more painful, especially in patients receiving electrical stimulation of cortex, and two of them refused cooperation. Conclusion TIVA and combined intravenousinhaled anesthesia are suitable for epilepsy surgery. We should control the timing and dosage seriously, and decide when to stop infusing or deep anesthesia. BIS monitoring is helpful.

Key words: epilepsy, anesthesia, bispectral index