Preservation of microelectrode recordings with non–GABAergic drugs during deep brain stimulator placement in children

Hippard, Helena Karlberg; Watcha, Mehernoor F.; Stocco, Amber; Curry, Daniel J.

doi:10.3171/2014.5.peds13103

Cited by 26 publications

(30 citation statements)

References 22 publications

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“…The two major conscious sedation techniques are asleep-awake-asleep (AAA) and monitored anaesthetic care (MAC) with sedation [11]. The former is usually not used with adult DBS as it requires general anaesthesia, but is commonplace in the pediatric population [12 ■■ ] given a more challenging age, inability to cooperate, as well as emotional instability. Furthermore, the most common indication for DBS in the pediatric population is poorly controlled dystonia, which makes it difficult to tolerate portions of an awake procedure [12 ■■ ].…”

Section: Anaesthetic Management and Implicationsmentioning

confidence: 99%

“…The former is usually not used with adult DBS as it requires general anaesthesia, but is commonplace in the pediatric population [12 ■■ ] given a more challenging age, inability to cooperate, as well as emotional instability. Furthermore, the most common indication for DBS in the pediatric population is poorly controlled dystonia, which makes it difficult to tolerate portions of an awake procedure [12 ■■ ]. Regardless, awake techniques provide the best conditions for intraoperative neurophysiology and stimulation testing.…”

Section: Anaesthetic Management and Implicationsmentioning

confidence: 99%

“…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.…”

Section: Anaesthetic Management and Implicationsmentioning

confidence: 99%

“…Anaesthesia is often induced with 3–3.5 mg/kg of propofol, in combination with a loading dose of 1 μg/kg of dexmedetomidine over 30 min with a maintenance infusion of 0.3–0.5 mg/kg/hr[12 ■■ ]. This is supplemented with remifentanil at 0.1 μg/kg/min and intermittent doses of ketamine of 0.05–0.02 mg/kg IV, all with the avoidance of volatile anaesthetic agents or nitrous oxide [12 ■■ ]. If blood pressure management is required, nicardipine is employed [12 ■■ ].…”

Section: Anaesthetic Management and Implicationsmentioning

confidence: 99%

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Anaesthesia for deep brain stimulation

Grant¹,

Gruenbaum

Gerrard³

2015

Current Opinion in Anaesthesiology

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Purpose of review Deep brain stimulation (DBS) is a well tolerated and efficacious surgical treatment for movement disorders, chronic pain, psychiatric disorder, and a growing number of neurological disorders. Given that the brain targets are deep and small, accurate electrode placement is commonly accomplished by utilizing frame-based systems. DBS electrode placement is confirmed by microlectrode recordings and macrostimulation to optimize and verify target placement. With a reliance on electrophysiology, proper anaesthetic management is paramount to balance patient comfort without interfering with neurophysiology. Recent findings To achieve optimal pain control, generous amounts of local anaesthesia are instilled into the planned incision. During the opening and closing states, conscious sedation is the prevailing method of anaesthesia. The preferred agents are dexmedetomidine, propofol, and remifentanil, as they affect neurocognitive testing the least, and shorter acting. All the agents are turned off 15–30 min prior to microelectrode recording. Dexmedetomidine has gained popularity in DBS procedures, but has some considerations at higher doses. The addition of ketamine is helpful for pediatric cases. Summary DBS is a robust surgical treatment for a variety of neurological disorders. Appropriate anaesthetic agents that achieve patient comfort without interfering with electrophysiology are paramount.

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Section: Anaesthetic Management and Implicationsmentioning

confidence: 99%

Section: Anaesthetic Management and Implicationsmentioning

confidence: 99%

Section: Anaesthetic Management and Implicationsmentioning

confidence: 99%

Section: Anaesthetic Management and Implicationsmentioning

confidence: 99%

See 2 more Smart Citations

Anaesthesia for deep brain stimulation

Grant¹,

Gruenbaum

Gerrard³

2015

Current Opinion in Anaesthesiology

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“…Avoiding drugs that potentiate GABAergic transmission, such as propofol, may offer potential benefits during MERs [46,47]. However, GA with propofol-remifentanil combination and successful identification of the subthalamic nucleus (STN) involving MERs and MRI techniques have been reported.…”

Section: General Anesthesiamentioning

confidence: 99%

Anesthetic Considerations for Deep Brain Stimulation

Fiorda-Diaz¹,

Stoicea²,

Deogaonkar³

et al. 2016

From Bench to Bedside - Trauma, Tumors, Spine, Functional Neurosurgery

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Deep brain stimulation (DBS) was used to treat refractory Parkinson's disease (PD) for the first time in 1987 by Professor Benabid's group by placing stimulating electrodes into targeted brain structures. DBS is a widely accepted neurosurgical treatment for Parkinson's disease (PD), benign tremor, dystonia, epilepsy, and other neuropsychiatric disorders with no significant changes in anatomical brain structures. Prior to the introduction of DBS, traditional treatment for PD involved surgical removal of parts of the brain known as thalamotomy, pallidotomy, and cingulotomy. Intraoperative identification of the affected areas of brain is possible through a couple of mechanisms involving electrical stimulation and monitoring of the brain function, known as "functional neurosurgery". Implantation of electrodes in the targeted area and the insertion of a programmable pulse generator under the clavicle or in the abdomen are the main steps in DBS surgery. Anesthetic management for DBS remains controversial and might vary between institutions and physicians. Although no guidelines have been developed, there are some common anesthetic considerations for DBS surgery, including difficult airway management, facilitation of neuromonitoring, and anesthetic drugs interference with microelectrode recordings (MERs). Local anesthesia, general anesthesia, and monitored anesthesia care (MAC) have been used worldwide in patients undergoing DBS.

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