Pioneering experience with awake craniotomy in a resource constrained environment

Abstract

Awake craniotomy (AC) enables maximal tumor resection near eloquent cortex, but its implementation in resource-limited settings presents distinct anesthetic challenges. We describe the establishment of an AC program in a low-resource neurosurgical center, emphasizing constraints related to team inexperience, limited patient literacy, absence of neuronavigation and cortical mapping, and restricted availability of short-acting anesthetic agents. Adaptive strategies included multidisciplinary training, simplified patient education materials, use of dexmedetomidine and ropivacaine for conscious sedation and scalp block, continuous intraoperative communication to compensate for lack of neurophysiologic monitoring, and dose conversions compatible with older infusion pumps. Despite these limitations, five ACs were successfully completed with stable sedation, adequate analgesia, and favorable patient cooperation. This article provides practical insights for anesthesiologists working in similar environments to help ensure successful and safe awake craniotomy practices in resource-constrained settings.

Keywords: Awake craniotomy; Neuronavigation; Neurosurgical center

Citation: Siraj S. Pioneering experience with awake craniotomy in a resource constrained environment. Anaesth. pain intensive care 2026;30(3):400-401. DOI: 10.35975/apic.v30i3.3185

Received: November 20, 2025; Revised: January 28, 2026; Accepted: January 31, 2026