title: Anaesthesia for deep brain stimulation: a review.
abstract: OBJECTIVE
  Deep brain stimulation (DBS) is a well tolerated and efficacious surgical treatment for movement disorders, chronic pain, psychiatric disorder, and a growing number of neurological disorders. Given that the brain targets are deep and small, accurate electrode placement is commonly accomplished by utilizing frame-based systems. DBS electrode placement is confirmed by microlectrode recordings and macrostimulation to optimize and verify target placement. With a reliance on electrophysiology, proper anaesthetic management is paramount to balance patient comfort without interfering with neurophysiology.
  
  
  RESULTS
  To achieve optimal pain control, generous amounts of local anaesthesia are instilled into the planned incision. During the opening and closing states, conscious sedation is the prevailing method of anaesthesia. The preferred agents are dexmedetomidine, propofol, and remifentanil, as they affect neurocognitive testing the least, and shorter acting. All the agents are turned off 15-30 min prior to microelectrode recording. Dexmedetomidine has gained popularity in DBS procedures, but has some considerations at higher doses. The addition of ketamine is helpful for pediatric cases.
  
  
  CONCLUSIONS
  DBS is a robust surgical treatment for a variety of neurological disorders. Appropriate anaesthetic agents that achieve patient comfort without interfering with electrophysiology are paramount.
authors: aDepartment of Neurosurgery bDepartment of Anesthesia, Yale School of Medicine, Yale-New Haven Medical Center, New Haven, Connecticut, USA.
authors: Ryan
authors: R
authors: Grant
authors: Shaun E
authors: SE
authors: Gruenbaum
authors: Jason
authors: J
authors: Gerrard
mesh_terms: D000758:Anesthesia / Q000379:methods*; D000777:Anesthetics; D046690:Deep Brain Stimulation / Q000379:methods*; D006801:Humans
chemical_list: D000777:Anesthetics