Effect of Anesthesia on Microelectrode Recordings During Deep Brain Stimulation Surgery: A Narrative Review

Bos, Michaël J.; Buhre, W.; Temel, Yasin; Joosten, Elbert A.J.; Absalom, Anthony; Janssen, Mark

doi:10.1097/ana.0000000000000673

Cited by 29 publications

(40 citation statements)

References 41 publications

(98 reference statements)

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“…Since the pharmacokinetic effects of these drugs are not mediated by GABA A receptors, their influence on STN neuronal activity is postulated to be less pronounced than of GABAergic agents. However, the available literature on non-GABA-mediated PSA effects on STN neuronal activity is sparse and consists largely of small uncontrolled retrospective case series with poor control over heterogeneity in patient cohorts [10][11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Influence of Anesthesia and Clinical Variables on the Firing Rate, Coefficient of Variation and Multi-Unit Activity of the Subthalamic Nucleus in Patients with Parkinson’s Disease

Bos

Sanchez

Bancone

et al. 2020

JCM

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Background: Microelectrode recordings (MER) are used to optimize lead placement during subthalamic nucleus deep brain stimulation (STN-DBS). To obtain reliable MER, surgery is usually performed while patients are awake. Procedural sedation and analgesia (PSA) is often desirable to improve patient comfort, anxiolysis and pain relief. The effect of these agents on MER are largely unknown. The objective of this study was to determine the effects of commonly used PSA agents, dexmedetomidine, clonidine and remifentanil and patient characteristics on MER during DBS surgery. Methods: Data from 78 patients with Parkinson’s disease (PD) who underwent STN-DBS surgery were retrospectively reviewed. The procedures were performed under local anesthesia or under PSA with dexmedetomidine, clonidine or remifentanil. In total, 4082 sites with multi-unit activity (MUA) and 588 with single units were acquired. Single unit firing rates and coefficient of variation (CV), and MUA total power were compared between patient groups. Results: We observed a significant reduction in MUA, an increase of the CV and a trend for reduced firing rate by dexmedetomidine. The effect of dexmedetomidine was dose-dependent for all measures. Remifentanil had no effect on the firing rate but was associated with a significant increase in CV and a decrease in MUA. Clonidine showed no significant effect on firing rate, CV or MUA. In addition to anesthetic effects, MUA and CV were also influenced by patient-dependent variables. Conclusion: Our results showed that PSA influenced neuronal properties in the STN and the dexmedetomidine (DEX) effect was dose-dependent. In addition, patient-dependent characteristics also influenced MER.

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Section: Introductionmentioning

confidence: 99%

Influence of Anesthesia and Clinical Variables on the Firing Rate, Coefficient of Variation and Multi-Unit Activity of the Subthalamic Nucleus in Patients with Parkinson’s Disease

Bos

Sanchez

Bancone

et al. 2020

JCM

Self Cite

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“…Various sedative and anesthetic drugs have been shown to distort the typical MER signature of the STN, putting in favor fully awake anesthetic protocol [14][15][16] . Nevertheless, it is not uncommon for awake DBS cases to be altered or aborted due to marked anxiety and non-cooperative patient .…”

Section: (Which Was Not Certified By Peer Review) Preprintmentioning

confidence: 99%

Ketamine Sedation Facilitates Asleep DBS: a multicenter retrospective study

Erdman

Kornilov

Kahana

et al. 2021

Preprint

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Deep brain stimulation (DBS) is commonly and safely performed for selective Parkinson's disease patients. Many centers perform DBS lead positioning exclusively under local anesthesia, to allow for brain microelectrode recordings (MER) and testing of stimulation-related therapeutic and side effects. These measures enable physiological identification of the DBS targets based on electrophysiological properties like firing rates and patterns, optimization of lead placement accuracy, and intra-operative evaluation of therapeutic window. Nevertheless, due to the challenges of awake surgery, some centers use sedation or general anesthesia, despite the distortion of discharge properties, and potential impact on clinical outcomes. Thus, there is a need for a novel anesthesia regimen that enables sedation without compromising intra-operative monitoring. This study investigates the use of low-dose ketamine for conscious sedation during lead positioning in subthalamic nucleus (STN) DBS for Parkinson's disease patients. Three anesthetic regimens were retrospectively compared in 38 surgeries across three DBS centers: 1) Interleaved propofol-ketamine (PK), 2) Interleaved propofol-awake (PA), and 3) Fully awake (AA). All anesthesia regimens achieved satisfactory MER. Automatic detection of STN borders and subdomains using a Hidden Markov Model was similar between the groups. Patients' symptoms and cooperation during stimulation testing in the ketamine group was not altered. No major adverse effects were reported in the different anesthesia protocols. These results support the use of low-dose ketamine as a novel alternative for the existing DBS anesthesia regimens, optimizing patient's experience while preserving lead placement accuracy. A prospective study should be performed to confirm these findings.

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“…In contrast, others have reported successful propofol use by combining anesthesia depth monitoring [ 18 , 19 ], target-controlled infusion (TCI) techniques [ 18 ], and a dosage reduction [ 18 , 20 ] during MER under propofol. These studies suggest that the contradictory results could be due to the various concentration, dose, mode, and timing of propofol administration [ 17 , 21 , 22 ]. Therefore, it is necessary to optimize propofol anesthesia for asleep DBS surgery.…”

Section: Introductionmentioning

confidence: 99%

Optimized Propofol Anesthesia Increases Power of Subthalamic Neuronal Activity in Patients with Parkinson’s Disease Undergoing Deep Brain Stimulation

Jiang

Yang

et al. 2021

Neurol Ther

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Introduction: Propofol is a general anesthetic option for deep brain stimulation (DBS) of the subthalamic nucleus (STN) of patients with Parkinson's disease (PD). However, its effects on STN activity and neuropsychological outcomes are controversial. The optimal propofol anesthesia for asleep DBS is unknown. This study investigated the safety and effectiveness of an optimized propofol anesthesia regimen in asleep DBS. Methods: This retrospective study enrolled 68 PD patients undergoing bilateral STN-DBS surgery. All patients received local scalp anesthesia, with (asleep group, n = 35) or without (awake group, n = 33) propofol-remifentanil general anesthesia by target-controlled infusion under electroencephalogram monitoring. The primary outcome was subthalamic neuronal spiking characterization during microelectrode recording. The secondary outcomes were clinical outcomes including motor, cognition, mind, sleep, and quality of life at 6 months. Results: Significantly increased delta and theta power were obtained under propofol anesthesia (awake vs. asleep group, mean ± standard deviation; delta: 31.97 ± 9.87 vs. 39.77 ± 10.56, p \ 0.01; theta: 21.09 ± 5.55 vs. 24.82 ± 6.63, p = 0.01). After excluding the influence of confounding factors of age and preoperative motor scores, there was a statistically significant influence on the delta, theta, and alpha power of STN neuronal activity under different anesthesia regimens (delta: b = 2.64, p \ 0.01; theta: b = 2.11, p \ 0.01; alpha: b = 1.42, p = 0.01). There were no differences in modified burst index, firing rate, tract numbers of microelectrode recording, and other clinical outcomes between the two groups.Nan Jiang and Yu-Ting Ling contributed equally to this work.

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Effect of Anesthesia on Microelectrode Recordings During Deep Brain Stimulation Surgery: A Narrative Review

Cited by 29 publications

References 41 publications

Influence of Anesthesia and Clinical Variables on the Firing Rate, Coefficient of Variation and Multi-Unit Activity of the Subthalamic Nucleus in Patients with Parkinson’s Disease

Influence of Anesthesia and Clinical Variables on the Firing Rate, Coefficient of Variation and Multi-Unit Activity of the Subthalamic Nucleus in Patients with Parkinson’s Disease

Ketamine Sedation Facilitates Asleep DBS: a multicenter retrospective study

Optimized Propofol Anesthesia Increases Power of Subthalamic Neuronal Activity in Patients with Parkinson’s Disease Undergoing Deep Brain Stimulation

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