Anesthesia for patients having deep brain stimulator implantation
- Lashmi Venkatraghavan, MD
Lashmi Venkatraghavan, MD
- Assistant Professor, Department of Anesthesia
- University of Toronto
Deep brain stimulation (DBS) is used to treat Parkinson disease and other neurologic conditions, as well as certain psychiatric disorders such as obsessive-compulsive disorder [1-4]. The indications for DBS have now expanded to include other conditions, and the number of centers performing this procedure has also increased [1,4-10]. The DBS system provides advantages over traditional surgical ablative procedures such as thalamotomy and pallidotomy, because it is non-destructive, reversible, and adjustable .
This topic discusses perioperative anesthetic management and potential perioperative complications in patients undergoing DBS implantation. Also, the anesthetic implications of a pre-existing implanted DBS system are discussed, since these patients may undergo subsequent surgical procedures. (See "Surgical treatment of Parkinson disease", section on 'Deep brain stimulation' and "Deep brain stimulation for treatment of obsessive-compulsive disorder" and "Treatment of dystonia", section on 'Deep brain stimulation' and "Surgical treatment of essential tremor", section on 'Deep brain stimulation'.)
The deep brain stimulation (DBS) hardware has three main components:
●Multi-contact intracranial quadripolar electrodes
●A programmable single- or dual-channel internal pulse generator (IPG) with battery unit
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- SURGICAL PROCEDURE
- Placement of stimulating electrodes
- Internalization of the electrodes
- Implantation of the internal pulse generator (IPG)
- PREOPERATIVE EVALUATION AND PREPARATION
- Procedure-related considerations
- Disease-specific considerations
- Patient preparation
- ANESTHESIA FOR PLACEMENT OF STIMULATING ELECTRODES
- Monitored anesthesia care (MAC)
- - Advantages of MAC
- - General considerations during MAC
- - Use of sedatives during MAC
- General anesthesia
- - Indications
- - Disadvantages
- Effect of anesthetic agents on target localization with microelectrode recording (MER)
- Effect of anesthetic agents on macrostimulation testing
- ANESTHESIA FOR IMPLANTATION OF THE INTERNAL PULSE GENERATOR (IPG)
- PERIOPERATIVE COMPLICATIONS IN PATIENTS UNDERGOING DBS IMPLANTATION
- ANESTHESIA FOR PATIENTS WITH PRE-EXISTING DEEP BRAIN STIMULATOR SYSTEMS
- Perioperative considerations
- Follow-up MRI examinations
- Replacement of the DBS battery unit
- SUMMARY AND RECOMMENDATIONS