Deep Brain Stimulation Surgery without Sedation

Zech, Nina; Seemann, Milena; Seyfried, Timo; Lange, Max; Schlaier, J.; Hansen, Ernil

doi:10.1159/000494803

Cited by 10 publications

(11 citation statements)

References 29 publications

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“…Accordingly, in many published studies, the patients were placed under monitored anaesthesia care, but propofol and remifentanil were still administered during certain parts of the procedure. 7 , 31 , 32 Patients with PD enter the OT in an off-medication state so their symptoms are likely maximal, as this facilitates testing and estimation. Nevertheless, this situation may be uncomfortable and even painful to many of them.…”

Section: Discussionmentioning

confidence: 99%

“… 1 , 6 Techniques to localise the target include intraoperative imaging, single or multi-microelectrode recordings (MERs), micro-/macrostimulation, and neurological intraoperative testing. 1 , 6 , 7 Moreover, the anaesthetic approach varies from monitored anaesthesia care to general anaesthesia depending on the preferences of the team at each centre. 6 , 7 , 8 , 9 At our centre, localisation is performed using a combination of MERs, microstimulation, and intraoperative neurological testing under conscious sedation with dexmedetomidine.…”

mentioning

confidence: 99%

“… 1 , 6 , 7 Moreover, the anaesthetic approach varies from monitored anaesthesia care to general anaesthesia depending on the preferences of the team at each centre. 6 , 7 , 8 , 9 At our centre, localisation is performed using a combination of MERs, microstimulation, and intraoperative neurological testing under conscious sedation with dexmedetomidine. 10 , 11 , 12 , 13 , 14 …”

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confidence: 99%

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Effects of dexmedetomidine on subthalamic local field potentials in Parkinson's disease

Martínez-Simón

Valencia

Cacho‐Asenjo

et al. 2021

British Journal of Anaesthesia

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Background: Dexmedetomidine is frequently used for sedation during deep brain stimulator implantation in patients with Parkinson's disease, but its effect on subthalamic nucleus activity is not well known. The aim of this study was to quantify the effect of increasing doses of dexmedetomidine in this population. Methods: Controlled clinical trial assessing changes in subthalamic activity with increasing doses of dexmedetomidine (from 0.2 to 0.6 mg kg À1 h À1 ) in a non-operating theatre setting. We recorded local field potentials in 12 patients with Parkinson's disease with bilateral deep brain stimulators (24 nuclei) and compared basal activity in the nuclei of each patient and activity recorded with different doses. Plasma levels of dexmedetomidine were obtained and correlated with the dose administered.Results: With dexmedetomidine infusion, patients became clinically sedated, and at higher doses (0.5e0.6 mg kg À1 h À1 ) a significant decrease in the characteristic Parkinsonian subthalamic activity was observed (P<0.05 in beta activity). All subjects awoke to external stimulus over a median of 1 (range: 0e9) min, showing full restoration of subthalamic activity. Dexmedetomidine dose administered and plasma levels showed a positive correlation (repeated measures correlation coefficient¼0.504; P<0.001). Conclusions: Patients needing some degree of sedation throughout subthalamic deep brain stimulator implantation for Parkinson's disease can probably receive dexmedetomidine up to 0.6 mg kg À1 h À1 without significant alteration of their characteristic subthalamic activity. If patients achieve a 'sedated' state, subthalamic activity decreases, but they can be easily awakened with a non-pharmacological external stimulus and recover baseline subthalamic activity patterns in less than 10 min.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Effects of dexmedetomidine on subthalamic local field potentials in Parkinson's disease

Martínez-Simón

Valencia

Cacho‐Asenjo

et al. 2021

British Journal of Anaesthesia

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“…Let us just do our job. You can put your mind at rest, we have done this a thousand times.” The difference when a patient is actively participating in the therapy is evident and very impressive in the case of awake craniotomies without sedation (Hansen et al, 2010; Seemann et al, 2015a; Zech et al, 2018). Here, the awake and guided patient contributes to his own brain surgery (deep brain stimulation or tumor resection in the vicinity of eloquent or motoric areas) by dissociation to, and creation of, a “safe place” and “reframing” of noises (e.g., drilling) and other disturbing sensations, thus avoiding pharmacologic sedation and allowing for unimpaired intraoperative neurological testing.…”

Section: Negative Suggestionsmentioning

confidence: 99%

Nocebo Effects and Negative Suggestions in Daily Clinical Practice – Forms, Impact and Approaches to Avoid Them

Hansen

Zech

2019

Front. Pharmacol.

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Medical situations are hot spots in the life of a patient with potentially long lasting effects arising from the use of either negative expressions or encouraging statements, or the lack of empathy or a positive physician-patient relationship. Health care personnel should be aware of and evaluate what patients are exposed to, hear and see. Knowing more about the effects of nocebos and negative suggestions, combined with increased attention to these matters, provides the basis for better recognition of detrimental influences in their own clinical environment and to be able to avoid, stop or neutralize them. After anamnesis patients should not be left with a focus on a negative past, but shifted to positive experiences prior to their illness, or to positive expectations in the future following surgery and rehabilitation. For example, after examining an injured leg the doctor should not turn to the computer for documentation unless he has shifted the patient’s focus on the other, unimpaired leg. “Is that painful too? No? Good! Can you feel that? Yes? Perfect! Can you bend that knee, move these toes? Great! That’s good.” This example draws attention to the fact that negative effects (discussed in the following) substantially are dependent on the focus of the patient and thus can be affected by focus shift and distraction. Patients, their symptoms and their healing are negatively affected by the omission of placebo effects, by nocebo effects and by negative suggestions.

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“…This is followed by implantation of generator subcutaneously under the upper chest wall. 6 Anaesthetic management of adult DBS requires neuro-anaesthesia team skilled in provision of sleep awake sleep technique (SAS). This needs preoperative psychological counseling and patients preparation like any awake neurosurgical technique.…”

Section: Introductionmentioning

confidence: 99%

Anaesthetic management of patients undergoing deep brain simulation: A retrospective review of 8 cases from a tertiary care center of Pakistan

et al. 2020

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Objectives: To review anaesthesia related outcome, perioperative complications and overall length of stay (LOS) in hospital for patients who had deep brain stimulation (DBS). Methods: The study was retrospective review of patients medical records diagnosed with Parkinson disease (PD) and underwent DBS at The Aga Khan University Hospital, Karachi from 2017-2019. Data was reviewed from file notes and patient chart and recorded on predesigned Performa. Frequency and percentages were used to present the data. Results: All patients were anaesthetized using Sleep-Awake-Sleep technique (SAS). Dexmedetomidine was mainly used for conscious sedation. Bispectral index monitor (BIS) was used to monitor the depth of sedation, and kept between 70-85 during sedative phase. All patients had successful intraoperative neurological monitoring, stimulation, and placement of electrodes. Total duration of anesthesia varied significantly in between the patients. Maximum duration was 600 minutes. None of our patient had any intraoperative event related to anaesthetic management. Overall five patients had some adverse events during ward stay. Mean LOS in hospital was four days. Conclusion: Anaesthetic management of DBS is well-tolerated. It requires dedicated team. The SAS technique is excellent for intraoperative neurophysiological monitoring. Careful selection of sedative agents and monitoring depth of anaesthesia using BIS would be beneficial in terms of improving related outcomes. doi: https://doi.org/10.12669/pjms.36.7.2870 How to cite this:Ahmed U, Shafiq F, Kumar D, Ahsan K, Ghaffar W, Bari E. Anaesthetic management of patients undergoing deep brain simulation: A retrospective review of 8 cases from a tertiary care center of Pakistan. Pak J Med Sci. 2020;36(7):---------. doi: https://doi.org/10.12669/pjms.36.7.2870 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Deep Brain Stimulation Surgery without Sedation

Cited by 10 publications

References 29 publications

Effects of dexmedetomidine on subthalamic local field potentials in Parkinson's disease

Effects of dexmedetomidine on subthalamic local field potentials in Parkinson's disease

Nocebo Effects and Negative Suggestions in Daily Clinical Practice – Forms, Impact and Approaches to Avoid Them

Anaesthetic management of patients undergoing deep brain simulation: A retrospective review of 8 cases from a tertiary care center of Pakistan

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