TY - JOUR
T1 - Benzodiazepine Sedation and Postoperative Neurological Deficits after Awake Craniotomy for Brain Tumor – An Exploratory Retrospective Cohort Study
AU - Plitman, Eric
AU - Chowdhury, Tumul
AU - Paquin-Lanthier, Gabriel
AU - Takami, Hirokazu
AU - Subramaniam, Sudhakar
AU - Leong, Kok Weng
AU - Daniels, Abigail
AU - Bernstein, Mark
AU - Venkatraghavan, Lashmi
N1 - Funding Information:
The results from the current study suggest that BZD use for sedation in awake craniotomy procedures is associated with a greater likelihood of postoperative neurological deficits. This assertion is supported by findings from previous literature. One previous study reported that BZD use was a trigger for post-stroke recrudescence (). Further, akin to the present work, transient worsening has been noted in patients with space-occupying lesions or an ischemic event specifically with midazolam usage (–). Moreover, there is evidence to support a phenomenon whereby neurological deficits associated with space-occupying lesions or ischemic events from which patients recovered are unmasked by BZD sedation. Previous studies have reported upon an association between midazolam use and transient unmasking of past neurological deficits (–). Notably, one study demonstrated reversibility of worsened deficits by treatment with flumazenil (). This body of literature has been summarized in greater detail within a recent systematic review on this topic ().
Publisher Copyright:
Copyright © 2022 Plitman, Chowdhury, Paquin-Lanthier, Takami, Subramaniam, Leong, Daniels, Bernstein and Venkatraghavan.
PY - 2022/4/20
Y1 - 2022/4/20
N2 - An awake craniotomy is a common neurosurgical procedure for excising brain tumor(s) located near or in eloquent areas. The use of benzodiazepine (BZD) for sedation in some patients with neuropathological conditions (e.g., stroke, brain tumors) has been previously linked with re-appearance of neurological deficits including limb incoordination, ataxia, and motor weakness, resulting in complications for the patient along with procedural challenges. Whether or not these findings can be extrapolated to patients undergoing brain tumor resection is largely unknown. The current work primarily sought to compare neurological outcome(s) in the immediate postoperative period between BZD-free and BZD-based sedation techniques in patients undergoing awake craniotomy. Using a database composed of awake craniotomies conducted within a single center and by a single surgeon, patients were retrospectively classified based on midazolam administration into BZD-free sedation (n=125) and BZD-based sedation (n=416) groups. Patients from each group were matched based on age, sex, tumor location, tumor grade, preoperative neurological deficits, non-operative BZD use, and Karnofsky Performance Scale scores, resulting in 108 patients within each group. Postoperative neurological deficits were recorded. Logistic regression analyses were conducted comparing postoperative neurological deficits between the matched groups. Postoperative neurological deficits were more prevalent within the BZD-based sedation group compared to the BZD-free sedation group (adjusted odds ratio (aOR)=1.903, 95% CI=1.018-3.560, p=0.044). In addition, subgroup analysis of the matched cohort showed a relationship between preoperative neurological symptoms and postoperative neurological deficits in the BZD-based sedation group (aOR=3.756, 95% CI=1.390-10.147, p=0.009). Our findings support the notion that the increased incidence of postoperative neurological deficits with BZD sedation may in part be related to the unmasking of preoperative neurological deficits. Further studies are required to confirm this phenomenon.
AB - An awake craniotomy is a common neurosurgical procedure for excising brain tumor(s) located near or in eloquent areas. The use of benzodiazepine (BZD) for sedation in some patients with neuropathological conditions (e.g., stroke, brain tumors) has been previously linked with re-appearance of neurological deficits including limb incoordination, ataxia, and motor weakness, resulting in complications for the patient along with procedural challenges. Whether or not these findings can be extrapolated to patients undergoing brain tumor resection is largely unknown. The current work primarily sought to compare neurological outcome(s) in the immediate postoperative period between BZD-free and BZD-based sedation techniques in patients undergoing awake craniotomy. Using a database composed of awake craniotomies conducted within a single center and by a single surgeon, patients were retrospectively classified based on midazolam administration into BZD-free sedation (n=125) and BZD-based sedation (n=416) groups. Patients from each group were matched based on age, sex, tumor location, tumor grade, preoperative neurological deficits, non-operative BZD use, and Karnofsky Performance Scale scores, resulting in 108 patients within each group. Postoperative neurological deficits were recorded. Logistic regression analyses were conducted comparing postoperative neurological deficits between the matched groups. Postoperative neurological deficits were more prevalent within the BZD-based sedation group compared to the BZD-free sedation group (adjusted odds ratio (aOR)=1.903, 95% CI=1.018-3.560, p=0.044). In addition, subgroup analysis of the matched cohort showed a relationship between preoperative neurological symptoms and postoperative neurological deficits in the BZD-based sedation group (aOR=3.756, 95% CI=1.390-10.147, p=0.009). Our findings support the notion that the increased incidence of postoperative neurological deficits with BZD sedation may in part be related to the unmasking of preoperative neurological deficits. Further studies are required to confirm this phenomenon.
KW - awake craniotomy
KW - benzodiazepine
KW - benzodiazepine sedation
KW - brain tumor
KW - midazolam
KW - neurological deficits
KW - neurological symptoms
UR - http://www.scopus.com/inward/record.url?scp=85129657368&partnerID=8YFLogxK
U2 - 10.3389/fonc.2022.885164
DO - 10.3389/fonc.2022.885164
M3 - Article
C2 - 35515117
AN - SCOPUS:85129657368
SN - 2234-943X
VL - 12
JO - Frontiers in Oncology
JF - Frontiers in Oncology
M1 - 885164
ER -