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Introduction: Different hormonal responses may appear in severe head injured patients (including increase in serum Cortisol & GH level). These changes can also be seen in recovery and rehabilitation periods, so influencing the patients, outcome.
Materials and Methods: Forty severely head injured patients, referred to emergency units of Alzahra & Kashani hospitals were studied in a cohort study (selected by convenient sampling) after dividing into two equal groups. Craniotomy was performed for one group and conservative (non-surgical) therapy for the other. In the first and seventh day of admission serum Cortisol and growth hormone were checked (using RIA method). Data was analyzed by paired and student t tests.
Results: There were significant differences between mean of GH in the first and also in the seventh day(both with P<0.05) and between mean of GH and Cortisol from first to seventh day in two study groups(P<0.05). But there were no significant differences between mean of Cortisol in the first or seventh day in two study groups.
Conclusion: Results of this study showed that craniotomy as an independent factor can raise serum GH and Cortisol levels in severely head injured patients.

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Introduction: Some intracranial surgeries must be performed while the patient is awake. Awake craniotomy is an intracranial surgical procedure in which the patient remains in a state of controlled consciousness while the surgery is performed. The aim of this study was to present a case of intracranial surgery to remove a tumor in the right frontal cortex using awake craniotomy.
Case Report: This report describes the anesthetic management of a 22-year-old male undergoing craniotomy with a fully awake technique. This was the first case of craniotomy performed entirely awake (from the beginning to the end of the operation) at Arak University of Medical Sciences and Valiasr Hospital in Arak, After preoperative preparation and evaluation, scalp nerve blocks targeting the cranial nerves innervating the scalp and head muscles were administered at specific sites. Mild sedation was provided using oxygen supplementation, followed by surgical incision. The lesion was examined intraoperatively while the patient remained awake, and the tumor was safely excised under full wakefulness. A combination of local and regional anesthesia and light intravenous sedation was utilized. Two types of local anesthetics, lidocaine 1.5% and bupivacaine 2.5%, were used for anesthesia, as well as intravenous sedatives and anesthetics such as propofol, remifentanil, and dexmedetomidine were administered for sedation. Throughout the operation, the patient was awake and breathing spontaneously, and the function of the brain nerves during the operation could be evaluated. Finally, the patient's surgery was performed without any complications and in stable condition, and the patient was transferred to the intensive care unit in good general condition, awake and fully alert.
Conclusions: Although maintaining analgesia and hemodynamic and adequate ventilation during fully awake craniotomy poses challenges, this technique is critical for intraoperative monitoring of cranial nerve function and preventing neurological deficits. By precisely administering scalp nerve blocks and carefully titrating sedatives (propofol, remifentanil, dexmedetomidine), we successfully performed the procedure under full wakefulness. With this method, potential surgical complications are prevented, and the patient also experiences satisfactory painlessness. Applying this technique was satisfactory for our patient.