Awake anesthesia allows patients to remain awake and responsive while experiencing minimal discomfort and anxiety during surgery, in contrast to general anesthesia, where the patient is unconscious. This article will provide an overview of the benefits and challenges in the use of awake anesthesia for surgery.

Awake anesthesia involves administering sedatives and analgesics to achieve a state of calm and pain relief while maintaining patient consciousness. Unlike general anesthesia, which renders the patient completely unconscious and requires intubation, awake anesthesia allows patients to breathe independently. The level of sedation can vary from minimal, where the patient is relaxed but fully awake, to moderate, where the patient might not remember much of the procedure but can still respond to verbal cues. The medications used for awake anesthesia typically include benzodiazepines, such as midazolam, for their anxiolytic properties, and opioids, such as fentanyl, for pain relief. Additionally, local anesthetics may be used to numb the specific area of surgery. The anesthesiologist carefully monitors the patient’s vital signs throughout the procedure to ensure safety and comfort ¹.

Awake anesthesia offers several benefits over general anesthesia. Firstly, it reduces the risks associated with general anesthesia, such as respiratory complications and adverse reactions to anesthesia drugs. Another significant advantage is the quicker recovery time. Patients often experience less postoperative grogginess and can recover more rapidly. This benefit is particularly valuable for outpatient procedures, allowing patients to return home sooner and resume normal activities faster. Furthermore, awake anesthesia can be cost-effective. The reduced need for extensive monitoring and shorter recovery periods can lower overall healthcare costs, making it an attractive option for both healthcare providers and patients ^2–4.

Awake anesthesia is suitable for a wide range of surgical procedures. It is commonly used in minor surgeries, such as dental procedures, endoscopies, and cataract surgeries. However, its application extends to more complex surgeries as well. One notable area is neurosurgery, particularly awake craniotomies. In these procedures, patients remain awake to allow surgeons to monitor brain function in real-time. This approach is crucial when operating near eloquent brain regions responsible for speech and motor functions. By interacting with the patient during surgery, surgeons can ensure they are not damaging critical areas, thereby improving outcomes and reducing postoperative deficits ⁵. Awake anesthesia is also used in certain orthopedic procedures, such as delicate hand surgeries, and can be invaluable when the surgeon must ensure they are protecting fine-motor function  ⁶.

While awake anesthesia offers numerous benefits, it is not without challenges. Patient selection is critical, as not all individuals are suitable candidates. Factors such as anxiety levels, ability to remain still, and overall health must be carefully evaluated. Additionally, effective communication between the patient, surgeon, and anesthesiologist is essential to ensure the patient’s comfort and cooperation during the procedure. Moreover, some patients may experience discomfort or anxiety despite sedation, and managing these reactions requires skill and experience from the anesthesiologist. Ensuring adequate pain control and preventing any distressing memories of the procedure are paramount for patient satisfaction ^1,7.

Awake anesthesia represents a versatile and patient-friendly option for surgery. Its ability to minimize risks, reduce recovery times, and lower costs makes it an increasingly popular choice in modern medicine. As techniques and medications continue to advance, the scope and efficacy of awake anesthesia are likely to expand, offering even more patients the benefits of this innovative approach to surgical care.

References

1.           Moore, B. A. & Barnett, J. E. General principles of regional anaesthesia. Case Stud. Clin. Psychol. Sci. Bridg. Gap from Sci. to Pract. 1–7 (2017). doi:10.1093/MED/9780199642045.003.0052

2.           Fiani, B. et al. Awake spine surgery: An eye-opening movement. Surg. Neurol. Int. 12, (2021). doi: 10.25259/SNI_153_2021

3.           Dohlman, L. E., Kwikiriza, A. & Ehie, O. Benefits and Barriers to Increasing Regional Anesthesia in Resource-Limited Settings. Local Reg. Anesth. 13, 147 (2020). DOI: 10.2147/LRA.S236550

4.           Stay Awake During Spine Surgery to Recuperate Faster, Go Home Sooner | Duke Health. Available at: https://www.dukehealth.org/blog/stay-awake-during-spine-surgery-recuperate-faster-go-home-sooner. (Accessed: 21st May 2024)

5.           Anesthesia for Awake Craniotomy – PubMed. Available at: https://pubmed.ncbi.nlm.nih.gov/34283419/. (Accessed: 21st May 2024)

6.           Different Types of Anesthesia During Orthopedic Surgery – Raleigh Orthopaedic Surgery Center. Available at: https://www.raleighsurgerycenter.com/surgery-center-nc​/different-types-of-anesthesia/. (Accessed: 21st May 2024)

7.           Tang, L. & Tan, T. K. Anaesthetic considerations and challenges during awake craniotomy. Singapore Med. J. (2024). doi:10.4103/singaporemedj.smj-2022-053