Perioperative Events During Deep Brain Stimulation: The Experience at Cleveland Clinic

Khatib, Reem; Ebrahim, Zeyd; Rezai, Ali R.; Cata, Juan P.; Boulis, Nicolas M.; Doyle, D. John; Schurigyn, Tamara; Farag, Ehab

doi:10.1097/ana.0b013e318157a15a

Cited by 80 publications

(76 citation statements)

References 14 publications

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“…Only a few previous studies have reported the use of sedatives during DBS implantation surgery, [11][12][13] and none provided a systematic investigation of sedative effects produced on neuron discharge. A recent study of propofol effects on population activity in the STN suggested that the sedative appeared to interfere with microelectrode recording identification; however, single-unit recordings were not undertaken.…”

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confidence: 99%

Human Subthalamic Neuron Spiking Exhibits Subtle Responses to Sedatives

et al. 2011

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Background: During deep brain stimulation implant surgery, microelectrode recordings are used to map the location of targeted neurons. The effects produced by propofol or remifentanil on discharge activity of subthalamic neurons were studied intraoperatively to determine whether they alter neuronal activity. Methods: Microelectrode recordings from 11 neurons, each from individual patients, were discriminated and analyzed before and after administration of either propofol or remifentanil. Subthalamic neurons in rat brain slices were recorded in patch-clamp to investigate cellular level effects. Results: Neurons discharged at 42 Ϯ 9 spikes/s (mean Ϯ SD) and showed a common pattern of inhibition that lasted 4.3 ms. Unique discharge profiles were evident for each neuron, seen using joint-interval analysis. Propofol (intravenous bolus 0.3 mg/kg) produced sedation, with minor effects on discharge activity (less than 2.0% change in frequency). A prolongation of recurrent inhibition was evident from jointinterval analysis, and propofol's effect peaked within 2 min, with recovery evident at 10 min. Subthalamic neurons recorded in rat brain slices exhibited inhibitory synaptic currents that were prolonged by propofol (155%) but appeared to lack tonic inhibitory currents. Propofol did not alter membrane potential, membrane resistance, current-evoked discharge, or holding current during voltage clamp. Remifentanil (0.05 mg/kg) had little effect on overall subthalamic neuron discharge activity and did not prolong recurrent inhibition.

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confidence: 99%

Human Subthalamic Neuron Spiking Exhibits Subtle Responses to Sedatives

et al. 2011

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“…In general, DBS in the asleep-awake-asleep technique is well tolerated in most patients, but in some it remains a bad experience, and a few will suffer from posttraumatic stress disorder [12, 17, 25]. The feeling of being left alone or to be at someone’s mercy, reported by some patients, cannot be treated pharmacologically, but by therapeutic communication and relationship building.…”

Section: Discussionmentioning

confidence: 99%

“…While there have been a few reports of DBS surgeries that were occasionally performed without sedation by employing local anaesthesia with monitored care [8, 17], this is the first report of DBS without the principal need for sedation. And as the base for this achievement, for the first time a specific technique of communication and care is described in this article for a non-pharmacological dealing with the patient’s strain and stress during DBS, with major implications for communication during regional anaesthesia in general.…”

Section: Introductionmentioning

confidence: 99%

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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“…Specific diseaserelated considerations, such as PD and obesity, should be evaluated with respect to airway management. Intraoperative larynx related neuromuscular dysfunction has been described in PD patients, increasing the potential risk of aspiration [43].…”

Section: Local 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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Perioperative Events During Deep Brain Stimulation: The Experience at Cleveland Clinic

Abstract: This retrospective study demonstrates that age is an independent risk factor for complications during DBS procedures. Monitored anesthesia care using propofol seems to be a safe technique for DBS procedures; however, dexmedetomidine can also be used.

Cited by 80 publications

References 14 publications

Human Subthalamic Neuron Spiking Exhibits Subtle Responses to Sedatives

Human Subthalamic Neuron Spiking Exhibits Subtle Responses to Sedatives

Deep Brain Stimulation Surgery without Sedation

Anesthetic Considerations for Deep Brain Stimulation

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