Background: Awake craniotomy (AC) is recommended for the resection of tumors in eloquent areas. It is traditionally performed under monitored anesthesia care (MAC), which relies on hypnotics and opioids. Hypnosis-assisted AC (HAAC) is an emerging technique that aims to provide psychological support while reducing the need for pharmacological sedation and analgesia. We aimed to compare the characteristics and outcomes of patients who underwent AC under HAAC or MAC. Methods: We retrospectively analyzed the clinical, anesthetic, surgical, and neuropsychological data of patients who underwent awake surgical resection of eloquent brain tumors under HAAC or MAC. We used Mann–Whitney U tests, Wilcoxon signed-rank tests, and repeated-measures analyses of variance to identify statistically significant differences at the 0.05 level. Results: A total of 22 patients were analyzed, 14 in the HAAC group and 8 in the MAC group. Demographic, radiological, and surgical characteristics as well as postoperative outcomes were similar. Patients in the HAAC group received less remifentanil (p= 0.047) and propofol (p= 0.002), but more dexmedetomidine (p= 0.025). None of them received ketamine as a rescue analgesic. Although patients in the HAAC group experienced higher levels of perioperative pain (p< 0.05), they reported decreasing stress levels (p= 0.04) and greater levels of satisfaction (p = 0.02). Conclusion: HAAC is a safe alternative to MAC as it reduces perioperative stress and increases overall satisfaction. Further research is necessary to assess whether hypnosis is clinically beneficial.
背景：清醒开颅手术（AC）被推荐用于切除功能区肿瘤。传统上，该手术在监测麻醉管理（MAC）下进行，依赖于镇静催眠药和阿片类药物。催眠辅助清醒开颅手术（HAAC）是一种新兴技术，旨在提供心理支持，同时减少对药物镇静和镇痛的需求。本研究旨在比较在HAAC或MAC下接受AC患者的特征和结局。 方法：我们回顾性分析了在HAAC或MAC下接受功能区脑肿瘤清醒手术切除患者的临床、麻醉、手术和神经心理学数据。我们使用Mann-Whitney U检验、Wilcoxon符号秩检验和重复测量方差分析来识别在0.05水平上具有统计学显著性的差异。 结果：共分析了22例患者，其中HAAC组14例，MAC组8例。人口统计学、影像学、手术特征以及术后结局均相似。HAAC组患者接受的瑞芬太尼（p=0.047）和丙泊酚（p=0.002）剂量较少，但右美托咪定（p=0.025）剂量较多。两组均未使用氯胺酮作为补救性镇痛药。尽管HAAC组患者围手术期疼痛水平较高（p<0.05），但他们报告的应激水平有所降低（p=0.04），并且满意度更高（p=0.02）。 结论：HAAC是MAC的一种安全替代方案，因为它能降低围手术期应激并提高总体满意度。需要进一步研究以评估催眠是否具有临床益处。
Hypnosis-Assisted Awake Craniotomy for Eloquent Brain Tumors: Advantages and Pitfalls
肿瘤(癌症)患者之家