Department of Anesthesiology, Qilu Hospital of Shandong University (Qingdao), No.758 Hefei Road, Qingdao, People's Republic of China.
Department of Anesthesia, Jewish Hospital and Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY, USA.
BMC Anesthesiol. 2019 Jan 17;19(1):14. doi: 10.1186/s12871-019-0685-y.
The asleep-awake-asleep (AAA) technique and laryngeal mask airway (LMA) is a common general anesthesia technique for deep brain stimulation (DBS) surgery. However, the LMA is not always the ideal artificial airway. In this report, we presented our experiences with nasotracheal intubation-extubation-intubation (IEI) and AAA techniques in DBS surgery for Parkinson's disease (PD) patients to meet the needs of surgery and ensure patients' safety and comfort.
Three PD patients scheduled for DBS surgery had to receive general anesthesia for various reasons. For the first asleep stage, general anesthesia and nasotracheal intubation was completed with routine methods. During the awake stage, we pulled the nasotracheal tube back right above the epiglottis under fiberoptic bronchoscope (FOB) guidance for microelectrode recording (MER), macrostimulation testing and verbal communication. Once monitoring is completed, we induced anesthesia with rapid sequence induction and utilized the FOB to advance the nasotracheal tube into the trachea again. To minimize airway irritations during the process, we sprayed the airway with lidocaine before any manipulation. The neurophysiologists completed neuromoinitroing successfully and all three patients were satisfied with the anesthesia provided at follow-up.
Nasotracheal IEI and AAA anesthetic techniques should be considered as a viable option during DBS surgery.
在深部脑刺激 (DBS) 手术中，睡眠-觉醒-睡眠 (AAA) 技术和喉罩气道 (LMA) 是一种常见的全身麻醉技术。然而，LMA 并不总是理想的人工气道。在本报告中，我们介绍了我们在帕金森病 (PD) 患者 DBS 手术中使用经鼻气管插管-拔管-插管 (IEI) 和 AAA 技术的经验，以满足手术需求并确保患者的安全和舒适。
由于各种原因，三名计划接受 DBS 手术的 PD 患者需要接受全身麻醉。对于第一睡眠阶段，我们采用常规方法完成全身麻醉和经鼻气管插管。在清醒阶段，我们在纤维支气管镜 (FOB) 引导下将鼻气管导管拉回会厌上方，进行微电极记录 (MER)、大刺激测试和言语交流。一旦监测完成，我们使用快速序列诱导进行麻醉，并再次使用 FOB 将鼻气管导管推进气管。为了在操作过程中尽量减少气道刺激，我们在进行任何操作之前先向气道喷洒利多卡因。神经生理学家成功地完成了神经监测，所有三名患者在随访时对提供的麻醉都感到满意。
在 DBS 手术中，经鼻 IEI 和 AAA 麻醉技术应被视为一种可行的选择。
