Influence of Propofol and Fentanyl on Deep Brain Stimulation of the Subthalamic Nucleus

Abstract

We investigated the effect of propofol and fentanyl on microelectrode recording (MER) and its clinical applicability during subthalamic nucleus (STN) deep brain stimulation (DBS) surgery. We analyzed 8 patients with Parkinson's disease, underwent bilateral STN DBS with MER. Their left sides were done under awake and then their right sides were done with a continuous infusion of propofol and fentanyl under local anesthesia. The electrode position was evaluated by preoperative MRI and postoperative CT. The clinical outcomes were assessed at six months after surgery. We isolated single unit activities from the left and the right side MERs. There was no significant difference in the mean firing rate between the left side MERs (38.7±16.8 spikes/sec, n=78) and the right side MERs (35.5±17.2 spikes/sec, n=66). The bursting pattern of spikes was more frequently observed in the right STN than in the left STN. All the electrode positions were within the STNs on both sides and the off-time Unified Parkinson's Disease Rating Scale part III scores at six months after surgery decreased by 67% of the preoperative level. In this study, a continuous infusion of propofol and fentanyl did not significantly interfere with the MER signals from the STN. The results of this study suggest that propofol and fentanyl can be used for STN DBS in patients with advanced Parkinson's disease improving the overall experience of the patients.Graphical Abstract

Anesthesia reduces discharge rates in the human pallidum without changing the discharge rate ratio between pallidal segments

“…General anesthesia with isoflurane depresses firing in both pallidal segments in dystonia. This is consistent with previous work showing a depressed firing rate in the GPi or STN under anesthesia (Hutchison et al, 2003;Raz et al, 2010;Moll et al, 2014) and contrasts with the unchanged firing rates in the STN found by others (Lettieri et al, 2012;Kim et al, 2014). This difference might be related to the anesthetic protocol, the recording site or the strict selection of units included in the analysis.…”

The Effects of Dexmedetomidine on Microelectrode Recordings of the Subthalamic Nucleus during Deep Brain Stimulation Surgery: A Retrospective Analysis

“…A critical limitation in our understanding of anesthetic best practices is that only a few studies have quantified the effect of anesthetics on MER [14,41,44,45], although a number have qualitatively assayed it, suggesting that too much sedation degrades the MER quality [13,14,15,20,39,41,42,43,44,46,47,48,49,50,51,52,53,54]. Considering those studies that quantified the effects on MER, we do know that some were affected by anesthetic choice, for example, during propofol sedation, background population activity within the STN, as well as FR, was reduced [13,14,41,43,44,51], REMI combined with ketamine demonstrated a reduction in background activity with preserved neuronal FRs [45], and REMI alone had no effect [41]. This study, combined with the results of the study by Krishna el al.…”

Anaesthesia for deep brain stimulation

“…Given that DBS patients have unique neurodegeneration or aberrant pathways, anaesthetic agents must be chosen appropriately to achieve anxiolysis without oversedation (Table 1) [11,12 ■■ ,13–17,18 ■■ , 19–22]. For blood pressure control, beta-blockers are avoided as they can mask or complicate intraoperative tremor testing.…”