Table 5.

Summary of clinical practice recommendations for awake craniotomies.

		Timing
Clinical Practice	Recommendations	Pre	Intra
Promote perception of control	Thoroughly prepare the patient
	Describe the progression of the procedure in detail	X
	Describe the operating room, expected discomforts, and unfamiliar sights and sounds the patient may hear	X	X
	Describe postoperative practices and procedures	X
	Cultivate a sense of purpose and teamwork
	Explain the value of the patient’s participation during the AC	X	X
	Describe the goals of the medical team	X	X
	Administer testing paradigms to be used during intraoperative mapping	X	X
	Explain that loss of function during mapping is temporary and informative	X	X
	Elicit the patient’s preferred stress management techniques	X	X
	Assess the patient’s coping style and need for information	X
	Teach and coach patients to assert control during the procedure through communication	X	X
	Be responsive to the patient’s intraoperative needs
	Administer additional medication as needed for pain management		X
	Provide water and adjust temperature or positioning, when possible, at the patient’s request		X
	Acknowledge the patient’s experience, even if there is no action that can be taken to address their concern		X
	Provide focused tasks and time frames
	Use focused tasks (e.g. neuropsychological tests, breathing exercises, requesting a moist oral swab) to divert attention from painful or stressful experiences		X
	Communicate expected time frames during the procedure	X	X
Establish compassionate and authentic relationships	Cultivate a sense of support
	Frequently inquire about the patient’s comfort level		X
	Repeat soothing statements of support and encouragement and avoid negative statements		X
	For providers working behind the patient, introduce yourself face-to-face after draping but before onset of the procedure (or after the patient is awake)		X
	Use nonverbal gestures, such holding the patient’s hand or placing a hand on their shoulder, to demonstrate compassion		X
	Provide an attentive and reliable human presence
	Station a provider (e.g. CP, SLP, or anaesthesiologist) near the patient and within his/her field of view		X
	If possible, have a CP or SLP conduct most direct patient interaction, allowing the anaesthesiologist to focus on anaesthesia management		X
	Provide consistency by having the same clinician conduct the preoperative evaluation and work with the patient in the OR	X	X
	Provide thorough and frequent communication
	Throughout the procedure, orient the patient what is happening, directly answer their questions and concerns, and inform them of new sensations they are about to experience		X
	Tailor the amount of detail provided to the patient’s coping style and need for information		X
Address intraoperative sensations	Offer suggestions to “reframe” distressing noises based on patient’s interests	X	X
	Ensure patient will not see potentially distressing items in his/her line of vison		X
Provide patient-centred anaesthesia management	Engage in multidisciplinary communication when planning patient-centred anaesthesia management	X	X