Anesthesia for deep brain stimulation

Abstract

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.