Clinical Experience with Dexmedetomidine for Implantation of Deep Brain Stimulators in Parkinson's Disease

Abstract

The pharmacologic profile of the alpha-2 agonist dexmedetomidine (Dex) suggests that it may be an ideal sedative drug for deep brain stimulator (DBS) implantation. We performed a retrospective chart review of anesthesia records of patients who underwent DBS implantation from 2001 to 2004. In 2003, a clinical protocol with Dex sedation for DBS implantation was initiated. Demographic data, use of antihypertensive medication, and duration of mapping were compared between patients who received Dex (11 patients/13 procedures) and patients who did not receive any sedation (controls: 8 patients/9 procedures). There were no differences in severity of illness between the two groups. Dex provided patient comfort and surgical satisfaction with mapping in all cases, and significantly reduced the use of antihypertensive medication (54% in the Dex group, versus 100% in controls, P = 0.048). In DBS implantation, sedation with Dex did not interfere with electrophysiologic mapping, and provided hemodynamic stability and patient comfort. Routine use of Dex in these procedures may be indicated.

Human Subthalamic Neuron Spiking Exhibits Subtle Responses to Sedatives

“…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.…”

Preservation of microelectrode recordings with non–GABAergic drugs during deep brain stimulator placement in children

“…15 Ketamine and remifentanil have fewer effects on spontaneous neuronal discharge during DBS placement. [11][12][13]21 The effect of mu receptor opioid agonists on the GABAergic system is less clear as there are animal studies that suggest these drugs could modulate the activity of GABA neurons via receptors located mainly at extrasynaptic sites on dendritic plasma membranes. 18 We therefore avoided the use of benzodiazepines, propofol, and volatile anesthetics and discontinued remifentanil during the MER phase.…”

“…2,20 This drug has become increasingly used as an anesthetic agent during functional neurosurgical procedures because it does not interfere with neurophysiological electrical signal monitoring and spontaneous basal ganglia neuron activity, and allows brain mapping during awake craniotomy and MER. 12,13 It has been used in both adult and pediatric patients who require intraoperative electrocorticography, cortical mapping, or neurocognitive testing. 2,8,16 Ketamine, a cyclohexanone derivate, interacts with N-methyl-D-aspartate subtype glutamate receptors, opioid receptors, monoaminergic receptors, muscarinic receptors, and calcium ion channels.…”

Controversial Issues in Deep Brain Stimulation in Parkinson's Disease

“…Avoiding medications that may interfere with MER can negatively affect patient safety, especially when the patient is agitated by a prolonged DBS procedure. However, it also is difficult to maintain a secure airway if the patient is too deeply unconscious [66][67]. In hypertensive patients, the alpha-2 agonist dexmedetomidine has been suggested as an effective sedative agent that may provide the patient comfort and good blood-pressure control and yet still allow satisfactory MER mapping by the neurophysiologist [67].…”