Awake anesthesia represents a ground-breaking shift in surgical care and comprises an increasing share of anesthesia procedures. Unlike general anesthesia, where patients are completely unconscious, awake anesthesia allows patients to remain alert or in a minimally sedated state while undergoing surgery. This approach has found many applications over the years, more recently in neurosurgery, orthopedic surgery, and certain cardiovascular procedures, due to its potential for improved patient outcomes and faster recovery times. Advances in anesthetic techniques, medications, and monitoring technology have made awake anesthesia a safer and more effective option for a wider range of surgeries.
Awake anesthesia offers several advantages over general anesthesia, particularly in terms of patient safety and postoperative recovery. For surgeries that involve critical areas like the brain or nervous system, keeping the patient conscious and able to move allows surgeons to monitor neurological function in real time, reducing the risk of damage to vital structures. In neurosurgery, for example, awake craniotomies enable the surgeon to test a patient’s motor and language functions during the procedure, minimizing the likelihood of postoperative deficits 1,2. These benefits have driven strong interest in advances in awake anesthesia for neurosurgery.
Additionally, awake anesthesia is associated with fewer side effects compared to general anesthesia. Patients often experience less postoperative nausea, vomiting, and grogginess, which are common with general anesthesia. Awake patients also tend to have a lower risk of respiratory complications and deep vein thrombosis, as they can breathe on their own and move shortly after the procedure. This leads to shorter hospital stays and faster recovery times 3,4.
Advances in awake anesthesia techniques have expanded the types of surgeries that can be performed while the patient remains conscious. One such advancement is the use of regional anesthesia, where specific areas of the body are numbed while the patient remains awake. Techniques such as spinal anesthesia, epidural anesthesia, and peripheral nerve blocks allow for precise control of pain and sensation, making surgeries on the limbs and even parts of the torso possible without the need for general anesthesia 5,6.
In addition to regional anesthesia, the development of advanced sedation protocols has been a key factor in the growth of awake surgery. Sedation medications, such as dexmedetomidine and propofol, can provide a state of calm and relaxation without completely losing consciousness. These drugs are titrated carefully to maintain a balance between patient comfort and cooperation 7,8.
Awake anesthesia has transformed the surgical landscape, offering patients a safer, more comfortable alternative to general anesthesia in many procedures. With advances in regional anesthesia techniques, sedation protocols, and monitoring technology, a growing number of surgeries can be performed under awake anesthesia.
References
- Lunardi, D. & Dinsmore, J. Anesthesia for Awake Craniotomy. Anaesth. Intensive Care Med. 23, 811–817 (2023).
- Anesthesia for Awake Craniotomy – StatPearls – NCBI Bookshelf. Available at: https://www.ncbi.nlm.nih.gov/books/NBK572053/.
- Awake vs. General Anesthesia | ABS Institute. Available at: https://absinstitute.com/awake-vs-general-anesthesia/.
- The Many Benefits of Wide-Awake Hand Surgery | Outpatient Surgery Magazine. Available at: https://www.aorn.org/outpatient-surgery/article/the-many-benefits-of-wide-awake-hand-surgery.
- Chui, K. et al. Awake Regional Anesthesia for Upper Limb Orthopedic Surgery During the COVID-19 Pandemic: Tips, Tricks, and Results. Tech. Orthop. 37, 16 (2022). doi: 10.1097/BTO.0000000000000562
- Regional Anaesthesia for Awake Hand Surgery: Block Failure and Troubleshooting Issues : Virtual Library. Available at: https://resources.wfsahq.org/atotw/regional-anaesthesia-for-awake-hand-surgery-block-failure-and-troubleshooting-issues/.
- Kim, S. H. & Choi, S. H. Anesthetic considerations for awake craniotomy. Anesth. Pain Med. 15, 269 (2020). doi: 10.17085/apm.20050
- D’Onofrio, G. et al. Anesthetic Management for Awake Craniotomy Applied to Neurosurgery. Brain Sci. 2023, Vol. 13, Page 1031 13, 1031 (2023).doi: 10.3390/brainsci13071031
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