Sedation During Surgery for Movement Disorders and Perioperative Neurologic Complications: An Observational Study Comparing Local Anesthesia, Remifentanil, and Dexmedetomidine.
BACKGROUND
The anesthetic management of patients requiring surgery for movement disorders needs to balance microrecording quality and patient cooperation with safety and comfort. Anesthetics can alter microrecording, although the effect on outcome is debatable. They also provide a rested and cooperative patient and minimize complications such as intracranial hemorrhage by providing better hemodynamic control. Most teams use local anesthesia with monitored anesthesia care or conscious sedation with propofol. Recently, dexmedetomidine has emerged as an alternative that, at low doses, does not affect microrecording, and that does not impair respiratory drive.


METHODS
In the past 15 years, we have used in our institution local anesthesia, remifentanil, or dexmedetomidine sedation. We compared functional outcome and rate of complications in a group of 145 patients with similar characteristics.


RESULTS
We found 5 (3.4%) intracranial hemorrhages. Two (1.4%) were symptomatic. The remifentanil group had the highest risk of having systolic blood pressure >160 mm Hg during surgery (odds ratio [OR], 2.8; 95% confidence interval [CI], 0.9-9.9), whereas the dexmedetomidine group had the lowest (OR, 0.7; 95% CI, 0.2-1.8), compared with the local anesthesia group. Surgical time was shortest with dexmedetomidine (mean, 283 minutes) and longest with local anesthesia only (mean, 328 minutes). Functional outcome (Unified Parkinson's Disease Rating Scale, Part III motor component scale) was similar among groups. The dexmedetomidine group had a statistically significant lower risk of perioperative neurologic events compared with the local anesthesia group (OR, 0.09; 95% CI, 0.002-0.68).


CONCLUSIONS
Sedation can be used safely without affecting outcome, and dexmedetomidine provides better hemodynamic management. Clinical significance remains unclear and larger studies need to be undertaken.
Department of Anesthesiology and Critical Care, Clínica Universidad de Navarra, Pamplona, Navarra, Spain. Electronic address: chonorato@unav.es.
Cristina
C
Honorato-Cia
Department of Anesthesiology and Critical Care, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
Antonio
A
Martinez-Simón
Neurology and Neurosurgery, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
Jorge
J
Guridi
Clínica Universidad de Navarra, Neurophysiology; CIMA Research Institute, Pamplona, Navarra, Spain.
Manuel
M
Alegre
Clínica Universidad de Navarra, Research Support Service, Avenida Pío XII, 31008, Pamplona, Spain.
Jorge M
JM
Nuñez-Cordoba
D000368:Aged; D000772:Anesthesia, Local / Q000379:methods*; D020927:Dexmedetomidine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000601:surgery*; D009422:Nervous System Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D019990:Perioperative Care / Q000379:methods*; D010880:Piperidines / Q000627:therapeutic use*; D000077208:Remifentanil; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
D010880:Piperidines; D020927:Dexmedetomidine; D000077208:Remifentanil
Complications; Dexmedetomidine; Movement disorders; Remifentanil; Sedation; Stereotactic and functional surgery