Pre-Op:  Awake Craniotomy for speech mapping: Preop: art line, 2 large PIV''s or CVL. (he doesn't mind CVL as blood loss can be an issue). Gorecki will do Scalp block with Marcaine w/epi in pre-op. High risk for emesis during stimulation-consider Emend in addition to full PONV prophylaxis. Intraop: MAC with Precedex preferred. May use Mayfield. Seizure also possible Intraop have BZD available. Also why Precedex is recommended.

Anesthesia:  Deep Brain Stimulation for patients with Parkinson's and essential tremors. This will be done in 2 parts- Part 1: Placement of the stimulator probes/ MAC anesthesia -3 to 4 hrs -deep sedation initially for Mayfield pins and Burr holes, then awake for stimulator placement -NO B-blockers, benzos or Parkinson's meds preop, as they interfere with testing -Precedex infusions from the start of case, fentanyl and Propofol are fine to use as well -he is requesting A lines for tight BP control ( mean 80-90 ), to be placed opposite side of the arm being stimulated -position can be beach chair or supine -foley catheter for females, men can use a urinal ( don't tolerate the foley as well ) -if a pulse generator is in place, can interfere with EKG- rep will be available to turn it off -pt to ICU post-op for BP control, neuro checks Part 2: Battery placement/ GA-45 min, 5 to 7 days later -battery placed SQ on either side of the chest -typically go home as an outpatient

Post-Op: