Huang Pin-Han, Pan Yu-Shen, Chen Shin-Yuan, Lin Sheng-Huang
School of Medicine, Tzu Chi University, Hualien, Taiwan.
Department of Neurosurgery, Hualien Tzu Chi Hospital/Tzu Chi University, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
Neuromodulation. 2025 Apr;28(3):414-424. doi: 10.1016/j.neurom.2024.04.002. Epub 2024 Jun 9.
Anesthetic agents used during deep brain stimulation (DBS) surgery might interfere with microelectrode recording (MER) and local field potential (LFP) and thus affect the accuracy of surgical target localization. This review aimed to identify the effects of different anesthetic agents on neuronal activity of the subthalamic nucleus (STN) during the MER procedure.
We used Medical Subject Heading terms to search the PubMed, EMBASE, EBSCO, and ScienceDirect data bases. MER characteristics were sorted into quantitative and qualitative data types. Quantitative data included the burst index, pause index, firing rate (FR), and interspike interval. Qualitative data included background activity, burst discharge (BD), and anesthetic agent effect. We also categorized the reviewed manuscripts into those describing local anesthesia with sedation (LAWS) and those describing general anesthesia (GA) and compiled the effects of anesthetic agents on MER and LFP characteristics.
In total, 26 studies on MER were identified, of which 12 used LAWS and 14 used GA. Three studies on LFP also were identified. We found that the FR was preserved under LAWS but tended to be lower under GA, and BD was reduced in both groups. Individually, propofol enhanced BD but was better used for sedation, or the dosage should be minimized in GA. Similarly, low-dose dexmedetomidine sedation did not disturb MER. Opioids could be used as adjunctive anesthetic agents. Volatile anesthesia had the least adverse effect on MER under GA, with minimal alveolar concentration at 0.5. Dexmedetomidine anesthesia did not affect LFP, whereas propofol interfered with the power of LFP.
The effects of the tested anesthetics on the STN in MER and LFP of Parkinson's disease varied; however, identifying the STN and achieving a good clinical outcome are possible under controlled anesthetic conditions. For patient comfort, anesthesia should be considered in STN-DBS.
在脑深部电刺激（DBS）手术中使用的麻醉剂可能会干扰微电极记录（MER）和局部场电位（LFP），从而影响手术靶点定位的准确性。本综述旨在确定不同麻醉剂在MER过程中对丘脑底核（STN）神经元活动的影响。
我们使用医学主题词检索了PubMed、EMBASE、EBSCO和ScienceDirect数据库。MER特征分为定量和定性数据类型。定量数据包括爆发指数、暂停指数、放电频率（FR）和峰间期。定性数据包括背景活动、爆发放电（BD）和麻醉剂效应。我们还将纳入综述的手稿分为描述局部麻醉联合镇静（LAWS）和描述全身麻醉（GA）的两类，并汇总了麻醉剂对MER和LFP特征的影响。
共识别出26项关于MER的研究，其中12项使用LAWS，14项使用GA。还识别出3项关于LFP的研究。我们发现，FR在LAWS下得以保留，但在GA下往往较低，且两组的BD均降低。单独来看，丙泊酚可增强BD，但更适合用于镇静，或在GA中应尽量减少其用量。同样，低剂量右美托咪定镇静不会干扰MER。阿片类药物可作为辅助麻醉剂。在GA下，挥发性麻醉对MER的不良影响最小，最低肺泡浓度为0.5。右美托咪定麻醉不影响LFP，而丙泊酚会干扰LFP的功率。
所测试的麻醉剂对帕金森病患者MER和LFP中的STN的影响各不相同；然而，在可控的麻醉条件下识别STN并取得良好的临床结果是可能的。为了患者舒适，在STN-DBS中应考虑麻醉。
