Factors predicting incremental administration of antihypertensive boluses during deep brain stimulator placement for Parkinson’s disease

Rajan, Shobana; Deogaonkar, Milind; Kaw, Roop; Nada, Eman; Hernandez, Adrián V.; Ebrahim, Zeyd; Avitsian, Rafi

doi:10.1016/j.jocn.2014.04.005

Cited by 8 publications

(5 citation statements)

References 26 publications

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“…Dexmedetomidine has been widely used over the past decade. 15 , 16 , 17 , 18 , 19 , 20 , 21 Whilst some groups administer it throughout the procedure, others discontinue it during testing. Although concerns exist about the possible influence of dexmedetomidine on testing and MER recording, 15 , 16 , 20 , 21 sedation is advisable to overcome anxiety or other complications, 13 , 33 especially in cases of bilateral procedures.…”

Section: Discussionmentioning

confidence: 99%

“… 15 , 16 , 17 , 18 , 19 , 20 , 21 Whilst some groups administer it throughout the procedure, others discontinue it during testing. Although concerns exist about the possible influence of dexmedetomidine on testing and MER recording, 15 , 16 , 20 , 21 sedation is advisable to overcome anxiety or other complications, 13 , 33 especially in cases of bilateral procedures. 10 , 29 Our patients achieved a sedated state (BIS <80 and closed eyes) during dexmedetomidine infusion, and all of them achieved the awake state after the external stimulus within a median time of 1 (range: 0–9) min.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, it does not affect the respiratory drive and causes only mild adverse events, including bradycardia and hypotension. 15 , 16 , 17 , 18 , 19 , 20 , 21 These properties make dexmedetomidine a good choice for STN–DBS electrode implantation. At low doses, dexmedetomidine does not appear to have a significant clinical effect on Parkinsonian symptoms.…”

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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%

Section: Discussionmentioning

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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“…The same risk factors determined the need to use aggressive antihypertensive therapy during the procedure. 18 Patients for DBS have to be in a "drugoff " state to elicit intraoperative mapping and clinical testing. Preoperative drugs used for the treatment of motor symptoms should be stopped on the night before surgery.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic Management in Bilateral Deep Brain Stimulation for X-linked Dystonia Parkinsonism: Early Single Institution Experience from the Philippines

Chiong-Perez¹,

Diesta²,

Oropilla³

2020

Acta Med Philipp

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X-linked dystonia-parkinsonism (XDP) is a rare, adult-onset, progressive, hereditary neurological movement disorder primarily affecting Filipino men with maternal families from Panay province of the Philippines. Medical treatment modalities currently being used have offered temporary symptomatic relief. Surgical management in the form of bilateral globus pallidi internae (Gpi) deep brain stimulation (DBS) has shown promising results and is increasingly being performed in advanced centers, as reported in international literature. Presented herein is the local experience of seven (7) retrospectively reviewed cases from February 2018 to February 2019 in a tertiary center in the Philippines with a particular focus on anesthetic management. All patients were male, from Panay, and presented with progressive dystonia and parkinsonism. All patients underwent planned bilateral, simultaneous DBS electrode, and implantable pulse generator (IPG) placement performed by a multidisciplinary team. Anesthetic management consisted of Bispectral Index (BIS) guided conscious sedation with low dose propofol and remifentanil infusions with a complete scalp nerve block (SB) at the start of the procedure then shifted to awake monitored anesthesia care during electrode placement, microelectrode recording (MER) and macro stimulation testing. All were put under general anesthesia with a supraglottic airway device during the placement of the internal pulse generator (IPG) in the infraclavicular area. All seven patients had successful localization, and insertion of the DBS electrode and discharged improved. The anesthetic management of the DBS used in these cases warrants further investigation and may lead to standardization of future practice.

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“…, 13 The benefits of dexmedetomidine include minimal suppressive effect on MER in low dose and a lower risk of respiratory depression 17 . A retrospective study of 19 patients found that dexmedetomidine provided better patient satisfaction and reduced the use of intraoperative antihypertensives compared with no anesthetics during DBS (monitored anesthetic care), 12 whereas the other retrospective study showed the addition of dexmedetomidine to propofol did not reduce the use of antihypertensives 18 . Dexmedetomidine has become the sedative agent of choice in many institutes because of its perceived benefits over the other agents, 7 , 19 although the evidence is limited and the number of patients in the studies are small.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Intraoperative Sedation on Surgical Outcomes of Deep Brain Stimulation Surgery

Chui

Alimiri

Parrent

et al. 2017

Can. J. Neurol. Sci.

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Factors predicting incremental administration of antihypertensive boluses during deep brain stimulator placement for Parkinson’s disease

Cited by 8 publications

References 26 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

Anesthetic Management in Bilateral Deep Brain Stimulation for X-linked Dystonia Parkinsonism: Early Single Institution Experience from the Philippines

The Effects of Intraoperative Sedation on Surgical Outcomes of Deep Brain Stimulation Surgery

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