Dexmedetomidine depresses neuronal activity in the subthalamic nucleus during deep brain stimulation electrode implantation surgery

Amlong, Corey A.; Rusy, Deborah A.; Sanders, Robert D.; Lake, Wendell; Raz, Aeyal

doi:10.1016/j.bjao.2022.100088

Cited by 3 publications

(7 citation statements)

References 38 publications

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“…Our study demonstrates an increase in low γ and a decrease in Δ/θ oscillatory cortical activity in prefrontal EEG recordings during ketamine administration, consistent with previous research 14,45 . The increase in cortical activity under ketamine is in contrast with robust attenuation of cortical and basal ganglia activity seen under hypnotic sedation (eg, propofol and dexmedetomidine), even 1 hour after drug cessation 22 . In line with the changes in prefrontal EEG activity, most patients under ketamine sedation in our study were in a good mood, sometimes even slightly euphoric, during surgery.…”

Section: Discussionsupporting

confidence: 91%

“…14,45 The increase in cortical activity under ketamine is in contrast with robust attenuation of cortical and basal ganglia activity seen under hypnotic sedation (eg, propofol and dexmedetomidine), even 1 hour after drug cessation. 22 In line with the changes in prefrontal EEG activity, most patients under ketamine sedation in our study were in a good mood, sometimes even slightly euphoric, during surgery. This is in agreement with the reported effect of ketamine on mood.…”

Section: Ketamine's Mechanism Of Actionsupporting

confidence: 80%

“…Despite its advantages, literature results on its impact on MER are inconsistent. Although some reports indicate similar clinical outcomes, 23‐25 at least one study shows a prominent decrease in basal ganglia activity (root mean square), crucial for defining STN borders during surgery 22 . Additionally, dexmedetomidine may induce undesirable hemodynamic instability effects such as hypertension 26 and sedative effects during macrostimulation 27 …”

Section: Discussionmentioning

confidence: 99%

“…Most sedatives in DBS surgery significantly affect MER quality, Parkinson's disease motor symptoms, and patient cooperation for clinical assessment. 2,[20][21][22] Dexmedetomidine is a commonly used substance in DBS surgery with MER. Despite its advantages, literature results on its impact on MER are inconsistent.…”

Section: Asleep or Not Asleep?mentioning

confidence: 99%

“…Although some reports indicate similar clinical outcomes, [23][24][25] at least one study shows a prominent decrease in basal ganglia activity (root mean square), crucial for defining STN borders during surgery. 22 Additionally, dexmedetomidine may induce undesirable hemodynamic instability effects such as hypertension 26 and sedative effects during macrostimulation. 27 Our study favors ketamine over awake DBS, aligning with our prior non-human primate and retrospective human studies.…”

Section: Asleep or Not Asleep?mentioning

confidence: 99%

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Interleaved Propofol‐Ketamine Maintains DBS Physiology and Hemodynamic Stability: A Double‐Blind Randomized Controlled Trial

Kornilov,

Baker Erdman,

Kahana

et al. 2024

Movement Disorders

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BackgroundThe gold standard anesthesia for deep brain stimulation (DBS) surgery is the “awake” approach, using local anesthesia alone. Although it offers high‐quality microelectrode recordings and therapeutic‐window assessment, it potentially causes patients extreme stress and might result in suboptimal surgical outcomes. General anesthesia or deep sedation is an alternative, but may reduce physiological testing reliability and lead localization accuracy.ObjectivesThe aim is to investigate a novel anesthesia regimen of ketamine‐induced conscious sedation for the physiological testing phase of DBS surgery.MethodsParkinson's patients undergoing subthalamic DBS surgery were randomly divided into experimental and control groups. During physiological testing, the groups received 0.25 mg/kg/h ketamine infusion and normal saline, respectively. Both groups had moderate propofol sedation before and after physiological testing. The primary outcome was recording quality. Secondary outcomes included hemodynamic stability, lead accuracy, motor and cognitive outcome, patient satisfaction, and adverse events.ResultsThirty patients, 15 from each group, were included. Intraoperatively, the electrophysiological signature and lead localization were similar under ketamine and saline. Tremor amplitude was slightly lower under ketamine. Postoperatively, patients in the ketamine group reported significantly higher satisfaction with anesthesia. The improvement in Unified Parkinson's disease rating scale part‐III was similar between the groups. No negative effects of ketamine on hemodynamic stability or cognition were reported perioperatively.ConclusionsKetamine‐induced conscious sedation provided high quality microelectrode recordings comparable with awake conditions. Additionally, it seems to allow superior patient satisfaction and hemodynamic stability, while maintaining similar post‐operative outcomes. Therefore, it holds promise as a novel alternative anesthetic regimen for DBS. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

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Section: Discussionsupporting

confidence: 91%

Section: Ketamine's Mechanism Of Actionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Asleep or Not Asleep?mentioning

confidence: 99%

Section: Asleep or Not Asleep?mentioning

confidence: 99%

See 3 more Smart Citations

Interleaved Propofol‐Ketamine Maintains DBS Physiology and Hemodynamic Stability: A Double‐Blind Randomized Controlled Trial

Kornilov,

Baker Erdman,

Kahana

et al. 2024

Movement Disorders

View full text Add to dashboard Cite

show abstract

Microelectrode assisted deep brain stimulation: Considerations for anesthesia

Janssen,

Bos

2024

Deep Brain Stimulation

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Deep brain stimulation surgery under ketamine induced conscious sedation: a double blind randomized controlled trial

Kornilov,

Erdman,

Kahana

et al. 2023

Preprint

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BackgroundThe gold standard anesthesia for deep brain stimulation (DBS) surgery is the “awake” approach, using local anesthesia alone. While it offers high-quality microelectrode recordings and clinical assessment of the stimulation therapeutic window, it potentially causes patients extreme stress and might result in suboptimal surgical outcomes. However, the alternative of general anesthesia or deep sedation dramatically reduces reliability of physiological navigation and therapeutic window assessment, thus potentially diminishing the accuracy of lead localization. We therefore designed a prospective double-blinded randomized controlled trial to investigate a novel anesthesia regimen of ketamine-induced conscious sedation for DBS surgery.MethodsPatients with Parkinson’s disease undergoing subthalamic nucleus DBS surgery were enrolled. Patients were randomly assigned to either the experimental or control group. During the physiological navigation phase, the experimental group received ketamine infusion at a dosage of 0.25 mg/kg/hr, while the control group received normal saline. Both groups received moderate propofol sedation before and after the physiological navigation phase. Primary outcomes were non-inferiority of electrophysiological quality, including multiunit recordings, EEG, EMG, bispectral index and lead localization accuracy according to postoperative CT scans. Secondary outcomes included patients’ satisfaction level measured using Iowa satisfaction with anesthesia scale for awake procedures. Potential side effects and adverse events were also monitored, including hemodynamics (blood pressure, heart rate) and cognition (hallucinations during surgery and early post-operative cognition using Montreal Cognitive Assessment).ResultsThirty patients, 15 from each group, were included in the study and analysed. Intra-operatively, the electrophysiological signature of the subthalamic nucleus was similar under ketamine and saline. Tremor amplitude was slightly lower under ketamine (p= 0.002). The accuracy of lead position was comparable in both groups. Postoperatively, patients in the ketamine group reported significantly higher satisfaction with anesthesia. The improvement in Unified Parkinson’s disease rating scale part-III was similar between the groups. No negative effects of ketamine on hemodynamic stability or cognition were reported perioperatively. Additionally, no procedure-related complications were reported in either group, besides one case of peri-lead edema in the control group.ConclusionThis study demonstrates that ketamine induced conscious sedation during physiological navigation in DBS surgery resulted in non-inferior intra-operative, post-surgical and patient satisfaction outcomes compared to the commonly used standard awake protocol, without major disadvantages. Future studies should investigate the applicability of this protocol in other awake neurosurgical procedures, such as DBS for other targets and indications, and awake craniotomy for tumor resection and epilepsy.

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Dexmedetomidine depresses neuronal activity in the subthalamic nucleus during deep brain stimulation electrode implantation surgery

Cited by 3 publications

References 38 publications

Interleaved Propofol‐Ketamine Maintains DBS Physiology and Hemodynamic Stability: A Double‐Blind Randomized Controlled Trial

Interleaved Propofol‐Ketamine Maintains DBS Physiology and Hemodynamic Stability: A Double‐Blind Randomized Controlled Trial

Microelectrode assisted deep brain stimulation: Considerations for anesthesia

Deep brain stimulation surgery under ketamine induced conscious sedation: a double blind randomized controlled trial

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