Department of Anesthesiology, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel.
Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel.
Mov Disord. 2024 Apr;39(4):694-705. doi: 10.1002/mds.29746. Epub 2024 Feb 23.
The gold standard anesthesia for deep brain stimulation (DBS) surgery is the "awake" approach, using local anesthesia alone. Although it offers high-quality microelectrode recordings and therapeutic-window assessment, it potentially causes patients extreme stress and might result in suboptimal surgical outcomes. General anesthesia or deep sedation is an alternative, but may reduce physiological testing reliability and lead localization accuracy.
The aim is to investigate a novel anesthesia regimen of ketamine-induced conscious sedation for the physiological testing phase of DBS surgery.
Parkinson's patients undergoing subthalamic DBS surgery were randomly divided into experimental and control groups. During physiological testing, the groups received 0.25 mg/kg/h ketamine infusion and normal saline, respectively. Both groups had moderate propofol sedation before and after physiological testing. The primary outcome was recording quality. Secondary outcomes included hemodynamic stability, lead accuracy, motor and cognitive outcome, patient satisfaction, and adverse events.
Thirty patients, 15 from each group, were included. Intraoperatively, the electrophysiological signature and lead localization were similar under ketamine and saline. Tremor amplitude was slightly lower under ketamine. Postoperatively, patients in the ketamine group reported significantly higher satisfaction with anesthesia. The improvement in Unified Parkinson's disease rating scale part-III was similar between the groups. No negative effects of ketamine on hemodynamic stability or cognition were reported perioperatively.
Ketamine-induced conscious sedation provided high quality microelectrode recordings comparable with awake conditions. Additionally, it seems to allow superior patient satisfaction and hemodynamic stability, while maintaining similar post-operative outcomes. Therefore, it holds promise as a novel alternative anesthetic regimen for DBS. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
深部脑刺激 (DBS) 手术的金标准麻醉是“清醒”方法，仅使用局部麻醉。虽然它提供了高质量的微电极记录和治疗窗评估，但它可能会给患者带来极大的压力，并可能导致手术效果不佳。全身麻醉或深度镇静是另一种选择，但可能会降低生理测试的可靠性，并导致定位精度降低。
旨在研究一种新的麻醉方案，即氯胺酮诱导的清醒镇静，用于 DBS 手术的生理测试阶段。
帕金森病患者接受丘脑底核 DBS 手术，随机分为实验组和对照组。在生理测试期间，两组分别接受 0.25mg/kg/h 氯胺酮输注和生理盐水。两组在生理测试前后均接受中等剂量异丙酚镇静。主要结局是记录质量。次要结局包括血流动力学稳定性、导联准确性、运动和认知结果、患者满意度和不良事件。
共纳入 30 例患者，每组 15 例。术中，氯胺酮和生理盐水组的电生理特征和导联定位相似。氯胺酮组的震颤幅度略低。术后，氯胺酮组患者对麻醉的满意度显著提高。两组患者的统一帕金森病评定量表第三部分的改善情况相似。术中未报告氯胺酮对血流动力学稳定性或认知功能的负面影响。
氯胺酮诱导的清醒镇静提供了与清醒状态相当的高质量微电极记录。此外，它似乎允许更高的患者满意度和血流动力学稳定性，同时保持相似的术后结果。因此，它有望成为 DBS 的一种新的替代麻醉方案。
