A case of craniotomy with intermittent tracheal extubation for speech mapping during surgery

We gave anesthesia for craniotomy in a 54-year-old man with intracranial tumor near the Broca speech centers causing facial nerve palsy and slight allophasis. Nasotracheal intubation was performed after intravenous administration of droperidol 15 mg and fentanyl 0.2 mg. The head was fix with 3 pins with the patient in the right lateral position, and endotracheal tube was withdrawn to the pharynx confirming the speech of the patient. The patient was intubated again using fiberscope after intravenous midazolam 3 mg with inhalation of nitrous oxide. Nitrous oxide was discontinued for 2 hours after the start of surgery for the speech mapping, and the patient emerged from anesthesia in 5 minutes. He pronounced the letters on cards during the speech mapping. After the successful mapping, the patient was intubated again using fiberscope after administration of fentanyl 0.1 mg. Anesthesia was maintained again with nitrous oxide. The patient recovered from anesthesia quickly after surgery without any events. On the post-operative round, the patient could not remember well the anesthetic induction and the awakening during the brain mapping. Three episodes of intubation caused no complications, and the neurological symptoms disappeared in several days.