avoleikkaus

Avoleikkaus is a surgical approach in which the patient is awake or only lightly sedated during the procedure, with anesthesia limited to local or regional techniques rather than general anesthesia. The term is used in Finnish medical literature to describe operations where patient responsiveness is preserved to allow real-time functional assessment and mapping when needed.

Common settings include neurosurgery for tumor resection or epilepsy surgery near functional cortex, as well as certain orthopedic and spinal procedures, ENT surgeries, and some dental or maxillofacial interventions. Techniques rely on local anesthetics, regional blocks, or mild sedation that preserves cooperative ability and critical reflexes. Intraoperative monitoring, such as language and motor mapping, may be employed to minimize neurological risk.

Rationale and benefits include reduced anesthesia-related complications, the ability to perform real-time assessment of function during the operation, potentially shorter recovery times, and suitability for patients with conditions that increase risk from general anesthesia. Awake approaches can also lower systemic exposure to anesthetic agents and facilitate rapid decision-making during the procedure.

Risks and limitations involve the need for patient cooperation and tolerance of discomfort, possible movement or anxiety, and the fact that not all procedures are appropriate for awake techniques. The approach requires a skilled, specialized team and facilities capable of rapid conversion to general anesthesia if needed.

History and development in the late 20th century linked awake techniques to advances in anesthesiology and intraoperative functional mapping, with awake craniotomy becoming a well-known application in neurosurgery.

See also:

- Awake craniotomy

- Regional anesthesia

- Local anesthesia

- Intraoperative neurophysiological monitoring