{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T04:38:40Z","timestamp":1770352720902,"version":"3.49.0"},"reference-count":16,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"8","license":[{"start":{"date-parts":[[2024,2,19]],"date-time":"2024-02-19T00:00:00Z","timestamp":1708300800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,2,19]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Awake craniotomy (AC) is performed to remove the lesions near or in eloquent areas, during which the patients are alert and without any airway instrument. Apnea is a severe complication in AC. Here, the authors describe a case of sudden apnea induced by unexpected local anesthesia of the brainstem during AC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 42-year-old male underwent AC for a large, recurrent, bilateral frontal lobe mass and experienced transient apnea and loss of brainstem reflexes during the surgery. The patient recovered spontaneous breath rhythm just a few minutes after the removal of a lidocaine cotton pledget, which was found near the patient\u2019s midbrain. Then the patient awoke and cooperated to finish the surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>The administration of a local anesthetic subdurally in AC is common but risky. The scouring action of cerebral spinal fluid can spread those agents and cause unexpected brainstem anesthesia. A lower concentration of the anesthetic and keeping away from the cistern can make it safer.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case23761","type":"journal-article","created":{"date-parts":[[2024,2,19]],"date-time":"2024-02-19T19:47:10Z","timestamp":1708372030000},"source":"Crossref","is-referenced-by-count":0,"title":["Brainstem anesthesia during awake craniotomy: illustrative case"],"prefix":"10.3171","volume":"7","author":[{"given":"Yun","family":"Chen","sequence":"first","affiliation":[{"name":"Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China"},{"name":"Departments of Anesthesiology"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mei","family":"Sun","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongmin","family":"Bai","sequence":"additional","affiliation":[{"name":"Neurosurgery, General Hospital of Southern Theatre Command of PLA, Guangzhou, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruixin","family":"Yang","sequence":"additional","affiliation":[{"name":"Neurosurgery, General Hospital of Southern Theatre Command of PLA, Guangzhou, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huan","family":"He","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"J Clin Anesth","first-page":"60","article-title":"Prolonged apnea after remifentanil","volume":"19","author":"Nelson RY","year":"2007","unstructured":"Nelson RY, Bretz B, Egan TD Prolonged apnea after remifentanil. J Clin Anesth. 2007;19(1):60\u201363."},{"issue":"3","key":"b2","series-title":"Cent Nerv Syst Agents Med Chem","first-page":"180","article-title":"Chemistry and effects of brainstem acting drugs","volume":"19","author":"Saganuwan SA","year":"2019","unstructured":"Saganuwan SA Chemistry and effects of brainstem acting drugs. Cent Nerv Syst Agents Med Chem. 2019;19(3):180\u2013186."},{"issue":"2","key":"b3","series-title":"Neurotoxicology","first-page":"206","article-title":"Dichlorvos-induced central apnea: effects of selective brainstem exposure in the rat","volume":"32","author":"Gaspari RJ","year":"2011","unstructured":"Gaspari RJ, Paydarfar D Dichlorvos-induced central apnea: effects of selective brainstem exposure in the rat. Neurotoxicology. 2011;32(2):206\u2013214."},{"issue":"9","key":"b4","series-title":"Reg Anesth Pain Med","first-page":"740","article-title":"Ultrasound detection of iatrogenic injury during peribulbar eye block: a cadaveric study","volume":"45","author":"Sadler A","year":"2020","unstructured":"Sadler A, McLeod G, McHardy PG, Wilkinson T Ultrasound detection of iatrogenic injury during peribulbar eye block: a cadaveric study. Reg Anesth Pain Med. 2020;45(9):740\u2013743."},{"issue":"7","key":"b5","series-title":"J Clin Anesth","first-page":"564","article-title":"Complications of ophthalmologic nerve blocks: a review","volume":"15","author":"Ahmad S","year":"2003","unstructured":"Ahmad S, Ahmad A Complications of ophthalmologic nerve blocks: a review. J Clin Anesth. 2003;15(7):564\u2013569."},{"issue":"1","key":"b6","series-title":"Emerg Med Australas","first-page":"83","article-title":"Brainstem anaesthesia after retrobulbar block: a rare cause of coma presenting to the emergency department","volume":"18","author":"Gunja N","year":"2006","unstructured":"Gunja N, Varshney K Brainstem anaesthesia after retrobulbar block: a rare cause of coma presenting to the emergency department. Emerg Med Australas. 2006;18(1):83\u201385."},{"issue":"2","key":"b7","series-title":"Anesth Analg","first-page":"e86","article-title":"The clinically relevant concentration of local anesthetics is a matter of consideration in the in\u00a0vitro study","volume":"131","author":"Kinoshita H","year":"2020","unstructured":"Kinoshita H, Kawahito S The clinically relevant concentration of local anesthetics is a matter of consideration in the in\u00a0vitro study. Anesth Analg. 2020;131(2):e86."},{"issue":"4","key":"b8","series-title":"Brain","first-page":"1040","article-title":"Dural and pial pain-sensitive structures in humans: new inputs from awake craniotomies","volume":"141","author":"Fontaine D","year":"2018","unstructured":"Fontaine D, Almairac F, Santucci S,  Dural and pial pain-sensitive structures in humans: new inputs from awake craniotomies. Brain. 2018;141(4):1040\u20131048."},{"issue":"1","key":"b1","series-title":"J Clin Anesth","first-page":"60","article-title":"Prolonged apnea after remifentanil","volume":"19","author":"Nelson RY","year":"2007","unstructured":"Nelson RY, Bretz B, Egan TD Prolonged apnea after remifentanil. J Clin Anesth. 2007;19(1):60\u201363."},{"issue":"3","key":"b2","series-title":"Cent Nerv Syst Agents Med Chem","first-page":"180","article-title":"Chemistry and effects of brainstem acting drugs","volume":"19","author":"Saganuwan SA","year":"2019","unstructured":"Saganuwan SA Chemistry and effects of brainstem acting drugs. Cent Nerv Syst Agents Med Chem. 2019;19(3):180\u2013186."},{"issue":"2","key":"b3","series-title":"Neurotoxicology","first-page":"206","article-title":"Dichlorvos-induced central apnea: effects of selective brainstem exposure in the rat","volume":"32","author":"Gaspari RJ","year":"2011","unstructured":"Gaspari RJ, Paydarfar D Dichlorvos-induced central apnea: effects of selective brainstem exposure in the rat. Neurotoxicology. 2011;32(2):206\u2013214."},{"issue":"9","key":"b4","series-title":"Reg Anesth Pain Med","first-page":"740","article-title":"Ultrasound detection of iatrogenic injury during peribulbar eye block: a cadaveric study","volume":"45","author":"Sadler A","year":"2020","unstructured":"Sadler A, McLeod G, McHardy PG, Wilkinson T Ultrasound detection of iatrogenic injury during peribulbar eye block: a cadaveric study. Reg Anesth Pain Med. 2020;45(9):740\u2013743."},{"issue":"7","key":"b5","series-title":"J Clin Anesth","first-page":"564","article-title":"Complications of ophthalmologic nerve blocks: a review","volume":"15","author":"Ahmad S","year":"2003","unstructured":"Ahmad S, Ahmad A Complications of ophthalmologic nerve blocks: a review. J Clin Anesth. 2003;15(7):564\u2013569."},{"issue":"1","key":"b6","series-title":"Emerg Med Australas","first-page":"83","article-title":"Brainstem anaesthesia after retrobulbar block: a rare cause of coma presenting to the emergency department","volume":"18","author":"Gunja N","year":"2006","unstructured":"Gunja N, Varshney K Brainstem anaesthesia after retrobulbar block: a rare cause of coma presenting to the emergency department. Emerg Med Australas. 2006;18(1):83\u201385."},{"issue":"2","key":"b7","series-title":"Anesth Analg","first-page":"e86","article-title":"The clinically relevant concentration of local anesthetics is a matter of consideration in the in\u00a0vitro study","volume":"131","author":"Kinoshita H","year":"2020","unstructured":"Kinoshita H, Kawahito S The clinically relevant concentration of local anesthetics is a matter of consideration in the in\u00a0vitro study. Anesth Analg. 2020;131(2):e86."},{"issue":"4","key":"b8","series-title":"Brain","first-page":"1040","article-title":"Dural and pial pain-sensitive structures in humans: new inputs from awake craniotomies","volume":"141","author":"Fontaine D","year":"2018","unstructured":"Fontaine D, Almairac F, Santucci S,  Dural and pial pain-sensitive structures in humans: new inputs from awake craniotomies. Brain. 2018;141(4):1040\u20131048."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/7\/8\/article-CASE23761.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/7\/8\/article-CASE23761.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/7\/8\/article-CASE23761.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T14:24:39Z","timestamp":1770301479000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/7\/8\/article-CASE23761.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,19]]},"references-count":16,"journal-issue":{"issue":"8"},"URL":"https:\/\/doi.org\/10.3171\/case23761","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,19]]}}}