title: General anaesthesia for deep brain stimulator electrode insertion in Parkinson's disease.
abstract: BACKGROUND
  This paper compares the use of general and local anaesthetic in patients having deep brain stimulator (DBS) surgery. It is a retrospective case note study of 46 patients treated consecutively with subthalamic nucleus stimulation for Parkinson's disease as practise changed in a Neurosurgical unit.
  
  
  METHODS
  The first 20 patients (LA group) had permanent electrodes placed under local anaesthesia. The remaining 26 patients (GA group) had the entire procedure under general anaesthesia. The groups were similar for age, sex, duration of Parkinson's disease and preoperative levodopa requirement.
  
  
  RESULTS
  The clinical results were similar in that within each group, the reduction in levodopa was not only clinically but also statistically significant (p < 0.001 for both, paired t test): for the LA group, the 6-month requirement was 39.4% (29.5-52.6%) of the preoperative requirement and for the GA group, the 6-month requirement was 32.3% (25.2-41.5%) of the preoperative requirement. The reduction in levodopa was maintained at 1 year. Of note, duration of surgery and length of stay were reduced. The mean duration of surgery was 8.2 h (7.8-8.6) for the LA group and 7.5 h (7.2-7.8) for the GA group (p = 0.003). The geometric mean of length of hospital stay was 5.4 days(4.6-6.3) for the LA group and 3.8 days (3.4-4.4) for the GA group (p = 0.001) There was no difference in electrophysiological recording.
  
  
  CONCLUSIONS
  This study describes benefits in the GA group for the entire procedure of STN DBS. In these samples, there was no difference in the adverse effects seen in patients undergoing deep brain stimulator insertion with general anaesthetic compared with local anaesthetic. The use of general anaesthetic did not detract from the known benefits of surgery.
authors.affiliation: Department of Anaesthesia, Queen Elizabeth Neuroscience Centre, University Hospital Birmingham NHS Foundation Trust, B15 2TH, Birmingham, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Sutcliffe
authors.forename: R D
authors.initials: RD
authors.lastname: Mitchell
authors.forename: Y C
authors.initials: YC
authors.lastname: Gan
authors.forename: A P
authors.initials: AP
authors.lastname: Mocroft
authors.forename: P
authors.initials: P
authors.lastname: Nightingale
mesh_terms: D000768:Anesthesia, General; D000772:Anesthesia, Local; D000978:Antiparkinson Agents / Q000008:administration & dosage; D046690:Deep Brain Stimulation; D004567:Electrodes, Implanted; D004739:England; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007902:Length of Stay; D007980:Levodopa / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D020531:Subthalamic Nucleus / Q000503:physiopathology; D013996:Time and Motion Studies
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa