title: Preservation of microelectrode recordings with non-GABAergic drugs during deep brain stimulator placement in children.
abstract: OBJECTIVE
  Deep brain stimulation (DBS) has become accepted therapy for intractable dystonia and other movement disorders. The accurate placement of DBS electrodes into the globus pallidus internus is assisted by unimpaired microelectrode recordings (MERs). Many anesthetic and sedative drugs interfere with MERs, requiring the patient to be awake for target localization and neurological testing during the procedure. In this study, a novel anesthetic technique was investigated in pediatric DBS to preserve MERs.
  
  
  METHODS
  In this paper, the authors describe a sedative/anesthetic technique using ketamine, remifentanil, dexmedetomidine, and nicardipine in 6 pediatric patients, in whom the avoidance of GABAergic stimulating drugs permitted excellent surgical conditions with no detrimental effects on intraoperative MERs. The quality of the MERs, and the frequency of its use in making electrode placement decisions, was reviewed.
  
  
  RESULTS
  All 6 patients had good-quality MERs. The data were of sufficient quality to make a total of 9 trajectory adjustments.
  
  
  CONCLUSIONS
  Microelectrode recordings in pediatric DBS can be preserved with a combination of dexmedetomidine and ketamine, remifentanil, and nicardipine. This preservation of MERs is particularly crucial in electrode placement in children.
authors.affiliation: Departments of Pediatrics and Anesthesiology;
authors.forename: Helena Karlberg
authors.initials: HK
authors.lastname: Hippard
authors.forename: Mehernoor
authors.initials: M
authors.lastname: Watcha
authors.forename: Amber J
authors.initials: AJ
authors.lastname: Stocco
authors.forename: Daniel
authors.initials: D
authors.lastname: Curry
mesh_terms: D000293:Adolescent; D000758:Anesthesia / Q000379:methods*; D019162:Anesthetics, Combined / Q000008:administration & dosage*; D000778:Anesthetics, Dissociative / Q000008:administration & dosage; D000959:Antihypertensive Agents / Q000008:administration & dosage; D002648:Child; D046690:Deep Brain Stimulation / Q000295:instrumentation / Q000379:methods; D020927:Dexmedetomidine / Q000008:administration & dosage; D004421:Dystonia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D020821:Dystonic Disorders / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007649:Ketamine / Q000008:administration & dosage; D008297:Male; D008839:Microelectrodes; D064926:Neurophysiological Monitoring; D009529:Nicardipine / Q000008:administration & dosage; D010880:Piperidines / Q000008:administration & dosage; D000077208:Remifentanil; D012890:Sleep; D014851:Wakefulness
chemical_list: D019162:Anesthetics, Combined; D000778:Anesthetics, Dissociative; D000959:Antihypertensive Agents; D006993:Hypnotics and Sedatives; D010880:Piperidines; D020927:Dexmedetomidine; D007649:Ketamine; D009529:Nicardipine; D000077208:Remifentanil
keywords: DBS = deep brain stimulation; GABA = γ-aminobutyric acid; GPi = globus pallidus internus; LMA = laryngeal mask anesthesia; MER = microelectrode recording; anesthesia; deep brain stimulation; functional neurosurgery; microelectrode recording; sedative