Propofol-induced Dyskinesias Controlled with Dexmedetomidine during Deep Brain Stimulation Surgery

Abstract

for the next 5 min. At this point, 1.5 g/kg dexmedetomidine was administered as a loading dose over 20 min. The patient’s dyskinesias subsided within 18 –20 min of dexmedetomidine infusion. The dexmedetomidine infusion rate was then reduced to 1.2 g kg 1 h 1 for another 10 min, after which it was continued at a rate of 0.2– 0.5 g kg 1 h 1 . When the infusion was stopped just before the microelectrode recordings, dyskinesias recurred. The dexmedetomidine infusion was restarted with good control of dyskinetic movements and titrated to keep the patient sufficiently awake to answer questions. Specifically, during microstimulation at the end of microelectrode recording for each tract, the patient was asked whether he experienced paresthesias or pulling in the muscles of his face, arms, or legs. During macrostimulation at the time of placement of the DBS electrodes, he was asked to move his fingers or toes. This allowed satisfactory placement of bilateral subthalamic nucleus DBS electrodes. Approximately an hour after surgery, the patient had another brief episode of dyskinesias that subsided spontaneously while he was in the postoperative care unit. The patient was off dexmedetomidine infusion at this time. The patient did well postoperatively and was discharged home without further problems. During his follow-up visit at 5 weeks, he reported improvement of all symptoms, indicating satisfactory DBS function.