Retrospective analysis of anesthesia for deep brain electrical stimulation in movement disorders

Abstract

Objective To analyze the merits and demerits, and main points of anesthetic management of different anesthesia regimens for deep brain stimulation (DBS) in movement disorders. Methods Recorded and summarized general information of 365 patients with movement disorders: 1) Local anesthesia combined with hypnoanalgesia: concentration of 1% lidocaine or 0.5% ropivacaine of local infiltration anesthesia, intravenous fentanyl (0.05-0.10 mg) and droperidol (1-2 mg) assisted sedation, analgesia. 2) Local anesthesia combined with intravenous anesthesia: local anesthesia implemented as above, in addition to intravenous fentanyl (0.05-0.10 mg), propofol 2-4 mg/(kg·h), midazolam 0.02-0.03 mg/kg. 3) Endotracheal intubation and general anesthesia: local anesthesia first, then anesthesia was induced with midazolam 0.03-0.05 mg/kg, fentanyl 2-3 μ g/kg, etomidate 0.10-0.20 mg/kg, vecuronium 0.10 mg/kg or rocuronium 0.70 mg/kg. Endotracheal intubation, was performed for mechanical ventilation after implementation. Anesthesia was maintained with continuous intravenous infusion of propofol 2-4 mg/(kg·h) and remifentanil 0.05 - 0.10 μ g/(kg·min). 4) Laryngeal mask anesthesia: firstly local anesthesia was performed as above. Then anesthesia was induced with midazolam 0.02-0.03 mg/kg, fentanyl 1-2 μg/kg, etomidate 0.10-0.20 mg/kg, vecuronium 0.10 mg/kg or rocuronium 0.70 mg/kg. Anesthesia maintenance was the same as the above. Recorded the incidence of intraoperative complications of four anesthesia regimens for deep brain stimulation. Results For local anesthesia combined with hypnoanalgesia (17.65%, 3/17) and local anesthesia combined with intravenous anesthesia (22.45%, 11/49), the incidence rate of respiratory depression was higher than the other two anesthesia (0/44, 0/255). The difference was not significant. The incidence of decreased blood pressure and increased blood pressure was higher in endotracheal intubation and general anesthesia group (29.55% and 13.64% ) than in laryngeal mask anesthesia group (8.24% and 0.78%). The difference was statistically significant (P = 0.000). Conclusion The condition of movement disorders patients is usually complex. Appropriate anesthesia regimens should be selected according to individual preoperative condition, concurrent diseases and operation requirements. Laryngeal mask anesthesia for DBS seems to be superior to other anesthesia regimens. DOI：10.3969/j.issn.1672⁃6731.2011.06.011

Keywords

• Electric stimulation therapy
• Anesthesia
• Movement disorders
• Intraoperative complications