Nobusada Shinoura, Ryoji Yamada, Kaoru Hatori, Hiroshi Sato and Kohei Kimura
To compare stress levels between awake craniotomy and craniotomy under general anesthesia, we analyzed
plasma levels of adrenaline, cortisol, adrenocorticotropic hormone (ACTH), noradrenaline and dopamine in a large
series of patients. Patients who underwent awake craniotomy in our hospital (n=110) were evaluated at 5 sample
times: immediately after arterial line insertion (T1); immediately after head fixation in a head frame (T2); 1 h after
start of incision (T3); immediately after relief of head fixation (T4); and immediately after arrival in the intensive care
unit (T5). Levels were then compared with those in 15 patients who underwent craniotomy under general
anesthesia. Plasma levels of adrenaline were significantly higher during awake craniotomy than in craniotomy under
general anesthesia at T1 to T4. Plasma levels of ACTH, cortisol, and noradrenaline in craniotomy were significantly
higher under general anesthesia than those in awake craniotomy at T5. No correlations were seen between plasma
levels of adrenaline in awake craniotomy and age, sex, preoperative Karnofsy Performance Scale score or
postoperative neurological status. In conclusion, plasma levels of adrenaline were significantly higher in awake
craniotomy than in craniotomy under general anesthesia during surgery, while plasma levels of cortisol, ACTH and
noradrenaline were significantly higher in craniotomy under general anesthesia than those in awake craniotomy just
after surgery.