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

Abstract

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.

Clinical Study of Intraoperative Microelectrode Recordings during Awake and Asleep Subthalamic Nucleus Deep Brain Stimulation for Parkinson’s Disease: A Retrospective Cohort Study

“…There are two typical forms of STN nuclear discharges. The lateral STN showed continuous and irregular high-frequency discharges with a high density of local neurons, while the medial STN showed a continuous and irregular medium and high-frequency discharges [ 9 , 10 ]. The discharge in the reticular part of the SN is regular, continuous, and high frequency, while the density of the local neurons is lower than that in the STN [ 11 ] ( Figure 2 ).…”

Risk Factors for Hiccups after Deep Brain Stimulation of Subthalamic Nucleus for Parkinson’s Disease

“…Preoperative localization and surgical procedures were similar to a previous study [ 31 ]. The brain was preoperatively scanned with 3T-MRI (signa excite; GE Medical Systems, Milwaukee, WI, USA) to identify and locate STN.…”

“…The anesthesia process was performed by the same anesthesiologist using a unified scheme. For more details, refer to the corresponding part of the previous study [ 31 ] (sedative drugs: propofol or etomidate, analgesic drugs: remifentanil and sufentanil). During the operation, CIS atracurium was used to maintain muscle relaxation and ventilator support.…”

Nomogram for Prediction of Postoperative Delirium after Deep Brain Stimulation of Subthalamic Nucleus in Parkinson’s Disease under General Anesthesia

“…Processes. Preoperative localization and surgical procedures were the same as those in previous studies [14]. Te head was scanned with a 3-T MRI (Signa Excite; GE Medical Systems, Milwaukee, WI, USA) to identify and locate STN.…”

“…Tere have been studies on the risk factors of delirium after DBS, but they were limited to awake DBS surgery and have not considered general anesthesia [4,10,11]. Since there are no unifed standards for anesthesia for DBS surgery, diferent centers use variable anesthesia methods such as local anesthesia, sedation, intraoperative awakening, or whole course general anesthesia [12][13][14][15]. In the past, considering that narcotic drugs may interfere with the recognition and positioning of intraoperative electrophysiological signals and afect the outcomes, most centers kept patients awake to cooperate with the operation [16][17][18].…”