In Reply

We thank Professor Bithal and Dr. Tomar for their interest in our study.¹ 

Their first question suggests that these patients had not been appropriately evaluated before and during the scheduled craniotomy. The study, as we indicated, was performed in the operating room immediately before the craniotomy. The patients had undergone all necessary and appropriate evaluations including imaging before surgery being scheduled. We see nothing to be gained by including every patient’s preoperative assessment in the article beyond the tumor diagnosis and imaging information. Further, pathologic diagnosis was obtained at craniotomy, and this was the basis for our reporting the pathologies and subgroups of glioma grades.

The answer to their second question, the number of oversedated patients who were excluded from the study, can be found in the article. Figure 2 shows the number of patients who were over- and undersedated and were therefore excluded.

Neurologic evaluation was performed once patients reached Observer's Assessment of Alertness/Sedation scale 4. The speed of onset depends on the pharmacologic characteristic of each sedative, e.g., propofol faster than dexmedetomidine. We did not specifically record the exact time for each patient. The duration of the effects we noted is indeed important. However, assessing the duration of an effect we had not yet demonstrated was not the aim of the study and its design. As the patients were anesthetized as soon as we completed our assessments, we cannot answer the question beyond stating that ongoing studies would address the question.