Download PDF
CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2016; 03(03): 197-204
DOI: 10.4103/2348-0548.190064
Review Article
Thieme Medical and Scientific Publishers Private Ltd.

Anaesthesia and deep brain stimulation

Barkha Bindu
1   Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
,
Parmod K. Bithal
1   Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
› Author Affiliations
Further Information

Publication History

Publication Date:
05 May 2018 (online)

Also available at
   Permissions and Reprints

Abstract

Deep brain stimulation (DBS) is becoming an increasingly popular minimally invasive surgical procedure for various movement disorders, especially Parkinson’s disease. Different nuclei have been identified depending on patients’ symptoms, but the success or failure of the procedure depends on various other factors such as proper patient selection and risk-benefit analysis. While various techniques of anaesthesia including monitored anaesthesia care, conscious sedation and general anaesthesia are being used routinely, no clear-cut evidence exists as to the best technique for this procedure. This review article discusses the surgical procedure of DBS, devices currently available, perioperative anaesthetic concerns and techniques, effect of anaesthetic drugs on microelectrode recordings and macro-stimulation and associated complications.

Keywords

Anaesthesia - deep brain stimulation - Parkinson’s disease
 

  • REFERENCES

  • 1 Dobbs P, Hoyle J, Rowe J. Anaesthesia and deep brain stimulation. Contin Educ Anaesth Crit Care Pain 2009; 9: 157-61
    CrossrefPubMedGoogle Scholar
  • 2 Blomstedt P, Hariz MI. Are complications less common in deep brain stimulation than in ablative procedures for movement disorders?. Stereotact Funct Neurosurg 2006; 84: 72-81
    CrossrefPubMedGoogle Scholar
  • 3 Rodriguez-Oroz MC, Obeso JA, Lang AE, Houeto JL, Pollak P, Rehncrona S. et al. Bilateral deep brain stimulation in Parkinson's disease: A multicentre study with 4 years follow-up. Brain 2005; 128 (Pt 10) 2240-9
    CrossrefPubMedGoogle Scholar
  • 4 Lang AE, Widner H. Deep brain stimulation for Parkinson's disease: Patient selection and evaluation. Mov Disord 2002; 17 Suppl (Suppl. 03) S94-101
    CrossrefPubMedGoogle Scholar
  • 5 Kitagawa M, Murata J, Kikuchi S, Sawamura Y, Saito H, Sasaki H. et al. Deep brain stimulation of subthalamic area for severe proximal tremor. Neurology 2000; 55: 114-6
    CrossrefPubMedGoogle Scholar
  • 6 Lee JY, Deogaonkar M, Rezai A. Deep brain stimulation of globus pallidus internus for dystonia. Parkinsonism Relat Disord 2007; 13: 261-5
    CrossrefPubMedGoogle Scholar
  • 7 Morrison CE, Borod JC, Perrine K, Beric A, Brin MF, Rezai A. et al. Neuropsychological functioning following bilateral subthalamic nucleus stimulation in Parkinson's disease. Arch Clin Neuropsychol 2004; 19: 165-81
    CrossrefPubMedGoogle Scholar
  • 8 Poon CC, Irwin MG. Anaesthesia for deep brain stimulation and in patients with implanted neurostimulator devices. Br J Anaesth 2009; 103: 152-65
    CrossrefPubMedGoogle Scholar
  • 9 Anderson VC, Burchiel KJ, Hogarth P, Favre J, Hammerstad JP. Pallidal vs. subthalamic nucleus deep brain stimulation in Parkinson disease. Arch Neurol 2005; 62: 554-60
    CrossrefPubMedGoogle Scholar
  • 10 Rezai AR, Kopell BH, Gross RE, Vitek JL, Sharan AD, Limousin P. et al. Deep brain stimulation for Parkinson's disease: Surgical issues. Mov Disord 2006; 21: S197-218
    CrossrefPubMedGoogle Scholar
  • 11 Okun MS, Tagliati M, Pourfar M, Fernandez HH, Rodriguez RL, Alterman RL. et al. Management of referred deep brain stimulation failures: A retrospective analysis from 2 movement disorders centers. Arch Neurol 2005; 62: 1250-5
    CrossrefPubMedGoogle Scholar
  • 12 Rodriguez RL, Fernandez HH, Haq I, Okun MS. Pearls in patient selection for deep brain stimulation. Neurologist 2007; 13: 253-60
    CrossrefPubMedGoogle Scholar
  • 13 Chakrabarti R, Ghazanwy M, Tewari A. Anesthetic challenges for deep brain stimulation: A systematic approach. N Am J Med Sci 2014; 6: 359-69
    CrossrefPubMedGoogle Scholar
  • 14 Venkatraghavan L, Luciano M, Manninen P. Review article: Anesthetic management of patients undergoing deep brain stimulator insertion. Anesth Analg 2010; 110: 1138-45
    PubMedGoogle Scholar
  • 15 Watson R, Leslie K. Nerve blocks versus subcutaneous infiltration for stereotactic frame placement. Anesth Analg 2001; 92: 424-7
    CrossrefPubMedGoogle Scholar
  • 16 Schulz U, Keh D, Barner C, Kaisers U, Boemke W. Bispectral index monitoring does not improve anesthesia performance in patients with movement disorders undergoing deep brain stimulating electrode implantation. Anesth Analg 2007; 104: 1481-7
    CrossrefPubMedGoogle Scholar
  • 17 Heavner JE. Local anesthetics. Curr Opin Anaesthesiol 2007; 20: 336-42
    CrossrefPubMedGoogle Scholar
  • 18 Costello TG, Cormack JR, Hoy C, Wyss A, Braniff V, Martin K. et al. Plasma ropivacaine levels following scalp block for awake craniotomy. J Neurosurg Anesthesiol 2004; 16: 147-50
    CrossrefPubMedGoogle Scholar
  • 19 Deiner S, Hagen J. Parkinson's disease and deep brain stimulator placement. Anesthesiol Clin 2009; 27: 391-415
    CrossrefPubMedGoogle Scholar
  • 20 Yamada K, Goto S, Kuratsu J, Matsuzaki K, Tamura T, Nagahiro S. et al. Stereotactic surgery for subthalamic nucleus stimulation under general anesthesia: A retrospective evaluation of Japanese patients with Parkinson's disease. Parkinsonism Relat Disord 2007; 13: 101-7
    CrossrefPubMedGoogle Scholar
  • 21 Lettieri C, Rinaldo S, Devigili G, Pauletto G, Verriello L, Budai R. et al. Deep brain stimulation: Subthalamic nucleus electrophysiological activity in awake and anesthetized patients. Clin Neurophysiol 2012; 123: 2406-13
    CrossrefPubMedGoogle Scholar
  • 22 Benarroch EE. Subthalamic nucleus and its connections: Anatomic substrate for the network effects of deep brain stimulation. Neurology 2008; 70: 1991-5
    CrossrefPubMedGoogle Scholar
  • 23 Maltête D, Navarro S, Welter ML, Roche S, Bonnet AM, Houeto JL. et al. Subthalamic stimulation in Parkinson disease: With or without anesthesia?. Arch Neurol 2004; 61: 390-2
    CrossrefPubMedGoogle Scholar
  • 24 Tao J, Nunery W, Kresovsky S, Lister L, Mote T. Efficacy of fentanyl or alfentanil in suppressing reflex sneezing after propofol sedation and periocular injection. Ophthal Plast Reconstr Surg 2008; 24: 465-7
    CrossrefPubMedGoogle Scholar
  • 25 Hutchison WD, Lang AE, Dostrovsky JO, Lozano AM. Pallidal neuronal activity: Implications for models of dystonia. Ann Neurol 2003; 53: 480-8
    CrossrefPubMedGoogle Scholar
  • 26 Raz A, Eimerl D, Bergman H. Propofol induced changes in the neuronal activity of subthalamic nucleus neurons. Anesthesiology 2008; 109: A838
    PubMedGoogle Scholar
  • 27 Lin SH, Chen TY, Lin SZ, Shyr MH, Chou YC, Hsieh WA. et al. Subthalamic deep brain stimulation after anesthetic inhalation in Parkinson disease: A preliminary study. J Neurosurg 2008; 109: 238-44
    CrossrefPubMedGoogle Scholar
  • 28 Sanghera MK, Grossman RG, Kalhorn CG, Hamilton WJ, Ondo WG, Jankovic J. Basal ganglia neuronal discharge in primary and secondary dystonia in patients undergoing pallidotomy. Neurosurgery 2003; 52: 1358-70
    CrossrefPubMedGoogle Scholar
  • 29 Elias WJ, Durieux ME, Huss D, Frysinger RC. Dexmedetomidine and arousal affect subthalamic neurons. Mov Disord 2008; 23: 1317-20
    CrossrefPubMedGoogle Scholar
  • 30 Rozet I. Anesthesia for functional neurosurgery: The role of dexmedetomidine. Curr Opin Anaesthesiol 2008; 21: 537-43
    CrossrefPubMedGoogle Scholar
  • 31 Lozano AM, Kumar R, Gross RE, Giladi N, Hutchison WD, Dostrovsky JO. et al. Globus pallidus internus pallidotomy for generalized dystonia. Mov Disord 1997; 12: 865-70
    CrossrefPubMedGoogle Scholar
  • 32 Khatib R, Ebrahim Z, Rezai A. Anesthetic complications during deep brain stimulation. Anesthesiology 2004; 101: A379
    PubMedGoogle Scholar
  • 33 Venkatraghavan L, Manninen P, Mak P, Lukitto K, Hodaie M, Lozano A. Anesthesia for functional neurosurgery: Review of complications. J Neurosurg Anesthesiol 2006; 18: 64-7
    CrossrefPubMedGoogle Scholar
  • 34 Khatib R, Ebrahim Z, Rezai A, Cata JP, Boulis NM, John Doyle D. et al. Perioperative events during deep brain stimulation: The experience at Cleveland clinic. J Neurosurg Anesthesiol 2008; 20: 36-40
    CrossrefPubMedGoogle Scholar
  • 35 Gorgulho A, De Salles AA, Frighetto L, Behnke E. Incidence of hemorrhage associated with electrophysiological studies performed using macroelectrodes and microelectrodes in functional neurosurgery. J Neurosurg 2005; 102: 888-96
    CrossrefPubMedGoogle Scholar
  • 36 Lotto M, Boulis NM. Intrathecal opioids for control of chronic low back pain during deep brain stimulation procedures. Anesth Analg 2007; 105: 1410-2
    CrossrefPubMedGoogle Scholar
  • 37 Voon V, Kubu C, Krack P, Houeto JL, Tröster AI. Deep brain stimulation: Neuropsychological and neuropsychiatric issues. Mov Disord 2006; 21 Suppl (Suppl. 14) S305-27
    CrossrefPubMedGoogle Scholar
  • 38 Castelli L, Rizzi L, Zibetti M, Angrisano S, Lanotte M, Lopiano L. Neuropsychological changes 1-year after subthalamic DBS in PD patients: A prospective controlled study. Parkinsonism Relat Disord 2010; 16: 115-8
    CrossrefPubMedGoogle Scholar