Subthalamic deep brain stimulation after anesthetic inhalation in Parkinson disease: a preliminary study

Abstract

The authors found that MER can be adequately performed while the patient receives a desflurane anesthetic, and the results can serve as a guide for STN electrode implantation. This may be a good alternative surgical method in patients with PD who are unable to tolerate deep brain stimulation surgery with local anesthesia.

Awake Neurophysiologically Guided versus Asleep MRI-Guided STN DBS for Parkinson Disease: A Comparison of Outcomes Using Levodopa Equivalents

“…The availability of this surgical technique provides patients unwilling or unable to tolerate awake surgery with an alternative option for DBS lead placement. Previous studies on asleep DBS lead placement with the use of intraoperative imaging have indicated that this may be an appropriate surgical technique, but only a limited number have evaluated the postoperative clinical outcomes in a quantitative fashion [6,8,10,12,13,14,15,16]. This study retrospectively compares the efficacy of STN DBS for PD in two groups of patients at a single institution.…”

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

“…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].…”

Controversial Issues in Deep Brain Stimulation in Parkinson's Disease

“…However, PD patients with obvious "off-medication" symptoms of anxiety, painful dystonia, and respiratory distress may not be good candidates for the lengthy tolerating the surgical procedures while awake [54][55][56][57]. In this section, we will report our own experience with general anesthesia during DBS surgery with MER and compare it with data from awake procedures (see Table 3).…”

“…It also is popular in neurosurgery because it can allow early extubation and facilitate early neurological evaluation [70][71]. MER also can be performed well at an anesthetic level of 0.8±0.2 minimum alveolar concentration (MAC) [54].…”

“…Hertel et al performed test stimulation to verify possible capsular effects when using low-voltage electrode stimulation, and the voltage causing the capsular effects may be incorrectly estimated if the excitability of the capsule has been decreased by general anesthesia. In our study, we did not perform test stimulation, but no patient suffered post-operative capsular effects because our selection criteria for the trajectory of electrode implantation chose the most appropriate track [54]. The knowledge of STN topography is crucial in general anesthesia DBS surgery; therefore, MER must be used as it is the only intra-operative tool to identify the STN, map its boundaries, and map its sensorimotor component through the detection of movementrelated neuronal firing [61,[63][64][65].…”