Deep brain stimulation under general anaesthesia for Parkinson's disease: A retrospective evaluation of perioperative events and anaesthetic management after switching away from conscious sedation.

Abstract

Background: Deep brain stimulation has become the standard of care for refractory Parkinson's disease. Neuroimaging advances have led to image-based targeting of the subthalamic nucleus under general anaesthesia (GA), an approach that renders unnecessary microelectrode recording and stimulation tests under local anaesthesia and conscious sedation (CS). We aimed to compare procedures and incidents related to each anaesthetic approach.

Methods: Retrospective descriptive comparison of deep brain stimulation under CS versus G. We collected patient and procedure data (e.g., comorbidities, difficult airway criteria, intraoperative monitoring, duration of surgery, hospitalization and motor outcomes) and reviewed intraoperative and postoperative haemodynamic, neurologic and surgery-related incidents.

Results: Seventy-eight procedures were analysed, 36 in the CS group (47.4%) and 42 in the GA group (52.6%). One-third of the patients were women, and the median age was 62 years (range, 33-75). In total, 23 patients experienced at least one perioperative incident, 19 (24.4%) in the CS group and 4 (5.1%) in the GA group (p < .001), even though the GA group included higher-risk patients (p < .05). Fourteen patients (17.9%) presented disorientation/agitation, 12 in the CS group (p < .01). The median duration of the surgery was 5.2 h (range, 3.5-9.2 h) in the CS group, split into two sessions, and 4.6 h (range, 4.1-5.2 h) in the GA group (p < .001). The median (interquartile range [IQR]) hospital stay was also longer in the CS group, at 7.5 days (IQR 6.75-10), compared to 3 days (IQR 3-4) in the GA group (p < .0001). Pre- and postoperative movement disorder evaluations for 38 of the 78 patients (49%) showed significantly improved scores after surgery. No differences were found between the two groups either before (p = .41) or after (p = .52) the surgery.

Conclusions: Deep brain stimulation under GA was associated with fewer perioperative incidents, shorter surgeries and shorter hospital stays.

Editorial comment: Patients with Parkinson's disease who are refractory to standard drug therapy may benefit from the implantation of deep-brain stimulating electrodes. In this report, imaging-guided electrode implantation under general anaesthesia was associated with fewer adverse perioperative events as well as shorter procedure times, compared to implantation guided by intraoperative electrode recording and stimulation under conscious sedation. Since imaging- and stimulation-guided implantation confers equal long-term benefits to motor function, the results from the current study suggest that general anaesthesia and imaging-guided implantation represent an overall quality improvement for these patients.