Anesthetic challenges for deep brain stimulation: A systematic approach

Abstract

Ablative intracranial surgery for Parkinson's disease has advanced to embedding electrodes into precise areas of the basal ganglia. Electrode implantation surgery, referred to as deep brain stimulation (DBS), is preferred in view of its reversibility, adjustability, and capability to be safely performed bilaterally. DBS is been increasingly used for other movement disorders, intractable tremors epilepsy, and sometimes chronic pain. Anesthesiologists need to amalgamate the knowledge of neuroanatomical structures and surgical techniques involved in placement of microelectrodes in defined cerebral target areas. Perioperative verbal communication with the patient during the procedure is quintessential and may attenuate the need for pharmacological agents. This review will endeavor to assimilate the present knowledge regarding the patient selection, available/practiced anesthesia regimens, and perioperative complications after our thorough search for literature published between 1991 and 2013.

Frameless Stereotactic Robot-Assisted Subthalamic Nucleus Deep Brain Stimulation: Case Report

“…MER was the surgeon's technique of choice of ensuring that the depth electrodes were placed in the correct location based upon audio feedback, because MER has been shown to be effective even under general anesthesia. 12 A subsequent intraoperative CT scan showed good positioning of the electrodes with no acute complications. Figure 2B shows the right electrode with an accuracy of 1.68 mm, whereas Figure 2D shows the left electrode with an accuracy of 1.14 mm.…”

Anesthetic Considerations for Deep Brain Stimulation

“…Respiratory complications (e.g., desaturation and airway obstruction) are the most feared during MAC, due to their association with devastating irreversible consequences [1,6].…”

“…Additionally, airway management during an "awaked" anesthetic technique should be considered. Stereotactic frame might represent a challenge during the surgery, limiting patients' airway access [6]. Specific diseaserelated considerations, such as PD and obesity, should be evaluated with respect to airway management.…”

“…Advantages and disadvantages have been described for each technique. Chakrabarti et al summarized anesthesia management during DBS surgery in three groups, based on patient considerations, surgical techniques, and disease-related [6].…”

“…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 [1,6]. Generators might work during a few years, depending on the stimulation rates, although some of them are rechargeable [5].…”