Amlong Corey, Rusy Deborah, Sanders Robert D, Lake Wendell, Raz Aeyal
Department of Anesthesiology, University of Wisconsin, Madison, WI, USA.
University of Sydney, Sydney, Australia.
BJA Open. 2022 Sep 9;3:100088. doi: 10.1016/j.bjao.2022.100088. eCollection 2022 Sep.
Micro-electrode recordings are often necessary during electrode implantation for deep brain stimulation of the subthalamic nucleus. Dexmedetomidine may be a useful sedative for these procedures, but there is limited information regarding its effect on neural activity in the subthalamic nucleus and on micro-electrode recording quality.
We recorded neural activity in five patients undergoing deep brain stimulation implantation to the subthalamic nucleus. Activity was recorded after subthalamic nucleus identification while patients received dexmedetomidine sedation (loading - 1 μg kg over 10-15 min, maintenance - 0.7 μg kg h). We compared the root-mean square (RMS) and beta band (13-30 Hz) oscillation power of multi-unit activity recorded by microelectrode before, during and after recovery from dexmedetomidine sedation. RMS was normalised to values recorded in the white matter.
Multi-unit activity decreased during sedation in all five patients. Mean normalised RMS decreased from 2.8 (1.5) to 1.6 (1.1) during sedation (43% drop, p = 0.056). Beta band power dropped by 48.4%, but this was not significant (p = 0.15). Normalised RMS values failed to return to baseline levels during the time allocated for the study (30 min).
In this small sample, we demonstrate that dexmedetomidine decreases neuronal firing in the subthalamic nucleus as expressed in the RMS of the multi-unit activity. As multi-unit activity is a factor in determining the subthalamic nucleus borders during micro-electrode recordings, dexmedetomidine should be used with caution for sedation during these procedures.
NCT01721460.
在丘脑底核深部脑刺激电极植入过程中，微电极记录常常是必要的。右美托咪定可能是这些操作中一种有用的镇静剂，但关于其对丘脑底核神经活动及微电极记录质量影响的信息有限。
我们记录了5例接受丘脑底核深部脑刺激植入术患者的神经活动。在识别出丘脑底核后记录活动，此时患者接受右美托咪定镇静（负荷剂量 - 1 μg/kg，10 - 15分钟内给予，维持剂量 - 0.7 μg/kg·小时）。我们比较了在右美托咪定镇静前、镇静期间及从镇静中恢复后，微电极记录的多单位活动的均方根（RMS）和β波段（13 - 30 Hz）振荡功率。RMS已根据在白质中记录的值进行了标准化。
所有5例患者在镇静期间多单位活动均减少。镇静期间平均标准化RMS从2.8（1.5）降至1.6（1.1）（下降43%，p = 0.056）。β波段功率下降了48.4%，但这无统计学意义（p = 0.15）。在研究规定的时间（30分钟）内，标准化RMS值未能恢复到基线水平。
在这个小样本中，我们证明右美托咪定可降低丘脑底核中的神经元放电，这在多单位活动的RMS中有所体现。由于多单位活动是微电极记录过程中确定丘脑底核边界的一个因素，在这些操作中使用右美托咪定进行镇静时应谨慎。
NCT01721460
