Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Curr Opin Anaesthesiol. 2011 Oct;24(5):495-9. doi: 10.1097/ACO.0b013e32834a894c.
Deep brain stimulation (DBS) is a well accepted treatment modality for many movement disorders such as Parkinson's disease and an increasing number of other functional neurological disorders like dystonias and epilepsy. This review will highlight the recent developments in our knowledge regarding the effects of anesthetic agents on neurophysiologic recording and anesthetic management of patients undergoing the insertion of a DBS.
There are new indications for DBS as well as new therapeutic target nuclei that are being examined. Better surgical technique and new imaging techniques like frameless stereotaxy are likely to improve patient tolerance of these procedures. The effects of anesthetic drugs on nuclei microelectrode recording and the need for an awake and cooperative patient for intraoperative macrostimulation testing continue to be the challenge for the anesthesiologist. Intracranial hemorrhage, seizures, and venous air embolism are the important perioperative complications needing urgent care. There are reports of increased incidence of postoperative behavioral and cognitive problems after DBS insertion.
There will continue to be an increase in the use of DBS for many neurological and functional disorders, especially in the aging baby boomer population. Anesthetic technique will vary depending on the prevalent practice in individual institutions and requirements of the specific surgical procedure.
深部脑刺激（DBS）是一种广泛接受的治疗方法，适用于许多运动障碍，如帕金森病，以及越来越多的其他功能性神经障碍，如肌张力障碍和癫痫。本文将重点介绍关于麻醉剂对神经生理记录的影响以及接受 DBS 植入手术的患者麻醉管理的最新知识进展。
DBS 的新适应证和新的治疗靶点核正在被研究。更好的手术技术和新的成像技术，如无框架立体定向技术，可能会提高患者对这些手术的耐受性。麻醉药物对核微电极记录的影响，以及在术中进行宏观刺激测试时需要清醒和合作的患者，仍然是麻醉师面临的挑战。颅内出血、癫痫发作和静脉空气栓塞是需要紧急处理的重要围手术期并发症。有报道称，DBS 植入术后患者的行为和认知问题发生率增加。
由于 DBS 在治疗许多神经和功能性疾病方面的应用不断增加，尤其是在老龄化的婴儿潮一代人群中，DBS 的应用将会增加。麻醉技术将根据各个机构的流行做法和特定手术程序的要求而有所不同。
