FRCPC, Department of Anesthesia, Toronto Western Hospital, University Health Network, Toronto, ON, Canada M5T 2S8.
Anesth Analg. 2010 Apr 1;110(4):1138-45. doi: 10.1213/ANE.0b013e3181d2a782. Epub 2010 Feb 8.
Deep brain stimulation is used for the treatment of patients with neurologic disorders who have an alteration of function, such as movement disorders and other chronic illnesses. The insertion of the deep brain stimulator (DBS) is a minimally invasive procedure that includes the placement of electrodes into deep brain structures for microelectrode recordings and intraoperative clinical testing and connection of the DBS to an implanted pacemaker. The anesthetic technique varies depending on the traditions and requirements of each institution performing these procedures and has included monitored anesthesia with local anesthesia, conscious sedation, and general anesthesia. The challenges and demands for the anesthesiologist in the care of these patients relate to the specific concerns of the patients with functional neurologic disorders, the effects of anesthetic drugs on microelectrode recordings, and the requirements of the surgical procedure, which often include an awake and cooperative patient. The purpose of this review is to familiarize anesthesiologists with deep brain stimulation by discussing the mechanism, the effects of anesthetic drugs, and the surgical procedure of DBS insertion, and the perioperative assessment, preparation, intraoperative anesthetic management, and complications in patients with functional neurologic disorders.
脑深部电刺激用于治疗功能改变的神经疾病患者，如运动障碍和其他慢性疾病。脑深部刺激器（DBS）的插入是一种微创程序，包括将电极插入深部脑结构进行微电极记录和术中临床测试，并将 DBS 与植入式起搏器连接。麻醉技术取决于进行这些手术的每个机构的传统和要求，包括局部麻醉下监测麻醉、清醒镇静和全身麻醉。麻醉师在这些患者护理方面面临的挑战和需求涉及到功能神经障碍患者的具体关注点、麻醉药物对微电极记录的影响以及手术要求，这些要求通常包括清醒和合作的患者。本综述的目的是通过讨论 DBS 插入的机制、麻醉药物的作用和手术过程，以及功能神经障碍患者的围手术期评估、准备、术中麻醉管理和并发症，使麻醉师熟悉脑深部电刺激。
