Controlled general anaesthesia for subthalamic nucleus stimulation in Parkinson's disease

Fluchère, Frédérique; Witjas, Tatiana; Eusebio, Alexandre; Bruder, Nicolas; Giorgi, Roch; Lévêque, Marc; Jc, Peragut; Jp, Azulay; Régis, Jean

doi:10.1136/jnnp-2013-305323

Cited by 60 publications

(72 citation statements)

References 39 publications

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“…Nevertheless, the starting point, namely the dosage in the 22 patients of the standard group is concordant with calculations based on the published mean dosage of 50–67 µg/kg/min for conscious sedation [9, 13, 17]. Also, the higher propofol dose in the first 4 patients with intubation corresponds to the dosage generally used for anaesthesia induction (2 mg/kg) and total intravenous anaesthesia (10 mg/kg/h) [3]. The reason for including patients preceding the intervention group as a “standard group” for comparison, although heterogeneous and smaller in size (but from the same hospital), was to cover the wide spectrum of protocols that are in clinical practice, besides calculating the doses of sedatives and analgesics from that information in the literature.…”

Section: Discussionsupporting

confidence: 61%

“…Hypertensive reactions in attacks of anxiety or panic have been described, as well as ischaemic heart attacks [32]. Respiratory distress, limited or disrupted cooperation and hallucinations have been described and listed as indication for general anaesthesia [3]. DBS surgery is a special and challenging situation for patients, especially for compromised PD patients.…”

Section: Discussionmentioning

confidence: 99%

“…the implantation of electrodes into deep brain structures and stimulation by a pacemaker, is a highly effective and safe method for the treatment of certain movement disorders like Parkinson’s disease (PD) and essential tremor [1, 2]. Although DBS has also been performed under general anaesthesia with good results [3, 4], placement and testing of the electrodes in the conscious patient is still considered the standard procedure [5-7]. There, the optimal position of the stimulator electrode is controlled and verified by stereotactic target localization, and in addition by intra-operative microelectrode recording (MER) and macrostimulation.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Deep Brain Stimulation Surgery without Sedation

Zech

Seemann

Seyfried

et al. 2018

Stereotact Funct Neurosurg

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Background: Sedatives and opioids used during deep brain stimulation (DBS) surgery interfere with optimal target localization and add to side effects and risks, and thus should be minimized. Objective: To retrospectively test the actual need for sedatives and opioids when cranial nerve blocks and specific therapeutic communication are applied. Methods: In a case series, 64 consecutive patients treated with a strong rapport, constant contact, non-verbal communication and hypnotic suggestions, such as dissociation to a “safe place,” reframing of disturbing noises and self-confirmation, were compared to 22 preceding patients under standard general anaesthesia or conscious sedation. Results: With introduction of the protocol the need for sedation dropped from 100% in the control group to 5%, and from a mean dose of 444 mg to 40 mg in 3 patients. Remifentanil originally used in 100% of the patients in an average dose of 813 µg was reduced in the study group to 104 µg in 31% of patients. There were no haemodynamic reactions indicative of stress during incision, trepanation, electrode insertion and closure. Conclusion: With adequate therapeutic communication, patients do not require sedation and no or only low-dose opioid treatment during DBS surgery, leaving patients fully awake and competent during surgery and testing.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Deep Brain Stimulation Surgery without Sedation

Zech

Seemann

Seyfried

et al. 2018

Stereotact Funct Neurosurg

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“…A critical limitation in our understanding of anesthetic best practices is that only a few studies have quantified the effect of anesthetics on MER [14,41,44,45], although a number have qualitatively assayed it, suggesting that too much sedation degrades the MER quality [13,14,15,20,39,41,42,43,44,46,47,48,49,50,51,52,53,54]. Considering those studies that quantified the effects on MER, we do know that some were affected by anesthetic choice, for example, during propofol sedation, background population activity within the STN, as well as FR, was reduced [13,14,41,43,44,51], REMI combined with ketamine demonstrated a reduction in background activity with preserved neuronal FRs [45], and REMI alone had no effect [41].…”

Section: Discussionmentioning

confidence: 99%

The Effects of Dexmedetomidine on Microelectrode Recordings of the Subthalamic Nucleus during Deep Brain Stimulation Surgery: A Retrospective Analysis

Mathews¹,

Camalier

Kla³

et al. 2017

Stereotact Funct Neurosurg

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Background: The placement of subthalamic nucleus (STN) deep brain stimulation (DBS) electrodes can be facilitated by intraoperative microelectrode recording (MER) of the STN. Objectives: Optimal anesthetic management during surgery remains unclear because of a lack of quantitative data of the effect of anesthetics on MER. Therefore, we measured the effects of dexmedetomidine (DEX) on MER measures of the STN commonly taken intraoperatively. Methods: MER from 45 patients was retrospectively compared between patients treated with remifentanil (REMI) alone or both REMI and DEX, which are the 2 main standards of care at our center. The measures examined were population activity, such as root mean square, STN length, and number of passes yielding STN, and the single-neuron measures of firing rate and variability. Results: The addition of DEX does not affect population measures (number of passes: DEX+REMI, n = 68, REMI only, n = 154), or neuronal firing rates (number of neurons: DEX+REMI, n = 64, REMI only, n = 72), but firing rate variability was reduced. Conclusions: In this cohort, population-based measures routinely used for electrode placement in the STN were unaffected by DEX when added to REMI. Neuronal firing rates were also unaffected, but their variability was reduced, even beyond 20 min after cessation.

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“…Follow-up assessments were performed by the same neurologist one year post-surgery (in 188 patients), with a five years follow-up accomplished in only 65 patients. Authors concluded that this particular anesthesia technique did not affect short-term and longterm motor outcomes [44].…”

Section: General Anesthesiamentioning

confidence: 99%

Anesthetic Considerations for Deep Brain Stimulation

Fiorda-Diaz¹,

Stoicea²,

Deogaonkar³

et al. 2016

From Bench to Bedside - Trauma, Tumors, Spine, Functional Neurosurgery

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Deep brain stimulation (DBS) was used to treat refractory Parkinson's disease (PD) for the first time in 1987 by Professor Benabid's group by placing stimulating electrodes into targeted brain structures. DBS is a widely accepted neurosurgical treatment for Parkinson's disease (PD), benign tremor, dystonia, epilepsy, and other neuropsychiatric disorders with no significant changes in anatomical brain structures. Prior to the introduction of DBS, traditional treatment for PD involved surgical removal of parts of the brain known as thalamotomy, pallidotomy, and cingulotomy. Intraoperative identification of the affected areas of brain is possible through a couple of mechanisms involving electrical stimulation and monitoring of the brain function, known as "functional neurosurgery". Implantation of electrodes in the targeted area and the insertion of a programmable pulse generator under the clavicle or in the abdomen are the main steps in DBS surgery. Anesthetic management for DBS remains controversial and might vary between institutions and physicians. Although no guidelines have been developed, there are some common anesthetic considerations for DBS surgery, including difficult airway management, facilitation of neuromonitoring, and anesthetic drugs interference with microelectrode recordings (MERs). Local anesthesia, general anesthesia, and monitored anesthesia care (MAC) have been used worldwide in patients undergoing DBS.

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Controlled general anaesthesia for subthalamic nucleus stimulation in Parkinson's disease

Cited by 60 publications

References 39 publications

Deep Brain Stimulation Surgery without Sedation

Deep Brain Stimulation Surgery without Sedation

The Effects of Dexmedetomidine on Microelectrode Recordings of the Subthalamic Nucleus during Deep Brain Stimulation Surgery: A Retrospective Analysis

Anesthetic Considerations for Deep Brain Stimulation

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