Sedation and Regional Anesthesia for Deep Brain Stimulation in Parkinson’s Disease

Abstract

Objective. To present the conscious sedation and the regional anesthesia technique, consisting of scalp block and superficial cervical plexus block, used in our institution for patients undergoing deep brain stimulation (DBS) for the treatment of Parkinson’s disease (PD).Methods. The study included 26 consecutive patients. A standardized anesthesia protocol was used and clinical data were collected prospectively.Results. Conscious sedation and regional anesthesia were used in all cases. The dexmedetomidine loading dose was 1 μg kg−1and mean infusion rate was 0.26 μg kg−1 h−1(0.21) [mean total dexmedetomidine dose: 154.68 μg (64.65)]. Propofol was used to facilitate regional anesthesia. Mean propofol dose was 1.68 mg kg (0.84) [mean total propofol dose: 117.72 mg (59.11)]. Scalp block and superficial cervical plexus block were used for regional anesthesia. Anesthesia related complications were minor. Postoperative pain was evaluated; mean visual analog scale pain scores were 0 at the postoperative 1st and 6th hours and 4 at the 12th and 24th hours. Values are mean (standard deviation).Conclusions. Dexmedetomidine sedation along with scalp block and SCPB provides good surgical conditions and pain relief and does not interfere with neurophysiologic testing during DBS for PD. During DBS the SCPB may be beneficial for patients with osteoarthritic cervical pain. This trial is registered with Clinical Trials IdentifierNCT01789385.

Dexmedetomidine as a Sedative in the Awake Implantation of a Neuromodulative System

“…Outcomes show promising results, such as good surgical conditions, patient comfort, and analgesia. Furthermore, dexmedetomidine provided a comparable hemodynamic stability during DBS implantation and this trial . A limitation of the present study is that we used an observational design with a small sample size, because our first aim was to examine the applicability of dexmedetomidine.…”

“…Furthermore, dexmedetomidine provided a comparable hemodynamic stability during DBS implantation and this trial. 10,11 A limitation of the present study is that we used an observational design with a small sample size, because our first aim was to examine the applicability of dexmedetomidine. Furthermore, we did not add the management of bradycardia in the study protocol because this is part of standard care.…”

Comparison of bispectral index and entropy monitoring in patients undergoing internalisation of deep brain stimulators

“…[27] Ozlu et al found that BIS values correlated with the level of sedation in patients with Parkinson's disease undergoing DBS. [19] To our knowledge, there are no studies assessing the use of DOA monitors during GA in patients with movement disorders. Abnormalities in EEG have been reported in patients with Parkinson's disease, and the presence of pathological alpha dominant rhythm was seen in patients with significant cognitive fluctuations.…”

“…There are only anecdotal observations of variability in the applicability of EEG-derived DOA monitors in patients with neurological disorders and psycho-pharmacotherapy. [18,19] Deep brain stimulation (DBS) is an increasingly popular treatment for patients with movement disorders such as Parkinson's disease and dystonia. Surgery for DBS is usually performed in two stages.…”