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Paterson A, Kumaria A, Sitaraman M, Sabbubeh T, Ingale H, Basu S. Dissection using pulsed radiofrequency energy device (PlasmaBlade) is safe and efficient in experimental revision neuromodulation implant surgery. Br J Neurosurg 2024; 38:439-446. [PMID: 33621158 DOI: 10.1080/02688697.2021.1885622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/22/2020] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The use of functional neurosurgical implants has increased over the past 10 years. PlasmaBlade is an innovative electrosurgical appliance harnessing pulsed radiofrequency (RF) energy. Our aim was to assess the risk of damage to neuromodulation hardware during PlasmaBlade dissection. MATERIALS AND METHODS A simulated setting with chicken breast threaded with different hardware and PlasmaBlade used in three configurations. . Post dissection, the wires were inspected naked eye and under an operating microscope. The induced current was assessed contemporaneously using an oscilloscope. RESULTS Five surgeons tested the PlasmaBlade at different generator settings. Sixty dissections were undertaken. No structural damage or induced current was identified at CUT 3/4, COAG 5. At CUT 6, COAG 5 and during dissection in a perpendicular orientation with prolonged hardware contact, opacification of insulation material occurred in 15/20 dissections. There was no dissolution of insulation even at this setting. On deviation from Medtronic advice, hardware damaged occurred if one was reckless with the PlasmaBlade. CONCLUSION When using the recommended settings and operational technique, PlasmaBlade dissection did not cause any damage to implant wiring/tubing in this simulated setting. This report seeks to add to clinical data suggesting PlasmaBlade is safe for dissection around deep brain stimulator (DBS), vagal nerve stimulator (VNS), and spinal cord stimulator (SCS) hardware.
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Affiliation(s)
- Alistair Paterson
- Department of Neurosurgery, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Ashwin Kumaria
- Department of Neurosurgery, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Murugan Sitaraman
- Department of Neurosurgery, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Thabit Sabbubeh
- Department of Neurosurgery, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Harshal Ingale
- Department of Neurosurgery, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Surajit Basu
- Department of Neurosurgery, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
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Dos Santos B, Vaz R, Braga AC, Rito M, Lucas D, Chamadoira C. Intracerebral hemorrhage after deep brain stimulation surgery guided with microelectrode recording: analysis of 297 procedures. NEUROCIRUGIA (ENGLISH EDITION) 2024; 35:79-86. [PMID: 37865159 DOI: 10.1016/j.neucie.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/13/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVES Report the incidence of symptomatic and asymptomatic intracerebral hemorrhage (ICH) in patients submitted to deep brain stimulation (DBS) guided with microelectrode recording (MER) with further analysis of potential risk factors, both inherent to the patient and related to the pathology and surgical technique. METHODS We performed a retrospective observational study. 297 DBS procedures were concluded in 277 patients in a single hospital centre between January 2010 and December 2020. All surgeries were guided with MER. We analysed the incidence of symptomatic and asymptomatic ICH and its correlation to age, sex, diagnosis, hypertension and perioperative hypertension, diabetes, dyslipidaemia, antiplatelet drugs, anatomic target, and number of MER trajectories. RESULTS There were a total of 585 electrodes implanted in 277 patients. 16 ICH were observed, of which 6 were symptomatic and 10 asymptomatic, none of which incurred in permanent neurological deficit. The location of the hemorrhage varied between cortical and subcortical plans, always in relation with the trajectory or the final position of the electrode. The incidence of symptomatic ICH per lead-implantation was 1%, and the CT-scan demonstrated asymptomatic ICH in 1.7% more patients. Male patients or with hypertension are 2.7 and 2.2 times more likely to develop ICH, respectively. However, none of these characteristics has been shown to have a statistically significant association with the occurrence of ICH, as well as age, diagnosis, diabetes, dyslipidaemia, antiplatelet drugs, anatomic target, number of MER trajectories and perioperative hypertension. CONCLUSIONS MER-guided DBS is a safe technique, with low incidence of ICH and no permanent deficits in our study. Hypertension and male sex seem to be risk factors for the development of ICH in this surgery. Nevertheless, no statistically significant factors were found for the occurrence of this complication.
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Affiliation(s)
| | - Rui Vaz
- Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal; Neurosurgery Department, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal
| | | | - Manuel Rito
- Neurosurgery Department, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal
| | - Diana Lucas
- Neurosurgery Department, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal
| | - Clara Chamadoira
- Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal; Neurosurgery Department, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal
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Alam MR, Singh S. Neuromodulation in Parkinson's disease targeting opioid and cannabinoid receptors, understanding the role of NLRP3 pathway: a novel therapeutic approach. Inflammopharmacology 2023:10.1007/s10787-023-01259-0. [PMID: 37318694 DOI: 10.1007/s10787-023-01259-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/26/2023] [Indexed: 06/16/2023]
Abstract
Parkinson's disease (PD) is a prevalent neurodegenerative disorder characterized by the progressive loss of dopaminergic neurons in the substantia nigra pars compacta, resulting in motor and non-motor symptoms. Although levodopa is the primary medication for PD, its long-term use is associated with complications such as dyskinesia and drug resistance, necessitating novel therapeutic approaches. Recent research has highlighted the potential of targeting opioid and cannabinoid receptors as innovative strategies for PD treatment. Modulating opioid transmission, particularly through activating µ (MOR) and δ (DOR) receptors while inhibiting κ (KOR) receptors, shows promise in preventing motor complications and reducing L-DOPA-induced dyskinesia. Opioids also possess neuroprotective properties and play a role in neuroprotection and seizure control. Similar to this, endocannabinoid signalling via CB1 and CB2 receptors influences the basal ganglia and may contribute to PD pathophysiology, making it a potential therapeutic target. In addition to opioid and cannabinoid receptor targeting, the NLRP3 pathway, implicated in neuroinflammation and neurodegeneration, emerges as another potential therapeutic avenue for PD. Recent studies suggest that targeting this pathway holds promise as a therapeutic strategy for PD management. This comprehensive review focuses on neuromodulation and novel therapeutic approaches for PD, specifically highlighting the targeting of opioid and cannabinoid receptors and the NLRP3 pathway. A better understanding of these mechanisms has the potential to enhance the quality of life for PD patients.
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Affiliation(s)
- Md Reyaz Alam
- Neuropharmacology Division, Department of Pharmacology, ISF College of Pharmacy, Moga, Punjab, 142001, India
| | - Shamsher Singh
- Neuropharmacology Division, Department of Pharmacology, ISF College of Pharmacy, Moga, Punjab, 142001, India.
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Kunkler B, Tung A, Patil PG, Chiravuri S, Tarnal V. Intrathecal catheter for severe low back pain during deep brain stimulation placement: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21285. [PMID: 35854910 PMCID: PMC9265218 DOI: 10.3171/case21285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/10/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) is a U.S. Food and Drug Administration–approved therapy for medically refractory Parkinson’s disease, essential tremor, and other neurological conditions. The procedure requires prolonged immobility and can result in significant patient discomfort, potentially limiting patient selection. In addition, surgical requirements necessitate avoidance of medications that may alter or suppress the patient’s arousal or baseline tremor during macrostimulation testing. OBSERVATIONS In this study, the authors describe the use of continuous spinal anesthesia with local anesthetic to manage a patient with severe back pain who was intolerant of semisupine position during stereotactic computed tomography and stage 1 of DBS placement. LESSONS Continuous spinal anesthesia is an effective strategy to manage patients with severe back pain undergoing DBS surgery for upper extremity motor symptoms.
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Affiliation(s)
| | | | - Parag G. Patil
- Neurological Surgery, University of Michigan Medical School, Ann Arbor, Michigan
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Jiang N, Ling YT, Yang C, Liu Y, Xian WB, Zhang LN, Guo QQ, Jin XY, Wu B, Zhang CM, Chen L, Zhang ZG, Liu JL. Optimized Propofol Anesthesia Increases Power of Subthalamic Neuronal Activity in Patients with Parkinson's Disease Undergoing Deep Brain Stimulation. Neurol Ther 2021; 10:785-802. [PMID: 34095990 PMCID: PMC8571439 DOI: 10.1007/s40120-021-00259-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/22/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Propofol is a general anesthetic option for deep brain stimulation (DBS) of the subthalamic nucleus (STN) of patients with Parkinson's disease (PD). However, its effects on STN activity and neuropsychological outcomes are controversial. The optimal propofol anesthesia for asleep DBS is unknown. This study investigated the safety and effectiveness of an optimized propofol anesthesia regimen in asleep DBS. Methods This retrospective study enrolled 68 PD patients undergoing bilateral STN-DBS surgery. All patients received local scalp anesthesia, with (asleep group, n = 35) or without (awake group, n = 33) propofol-remifentanil general anesthesia by target-controlled infusion under electroencephalogram monitoring. The primary outcome was subthalamic neuronal spiking characterization during microelectrode recording. The secondary outcomes were clinical outcomes including motor, cognition, mind, sleep, and quality of life at 6 months. Results Significantly increased delta and theta power were obtained under propofol anesthesia (awake vs. asleep group, mean ± standard deviation; delta: 31.97 ± 9.87 vs. 39.77 ± 10.56, p < 0.01; theta: 21.09 ± 5.55 vs. 24.82 ± 6.63, p = 0.01). After excluding the influence of confounding factors of age and preoperative motor scores, there was a statistically significant influence on the delta, theta, and alpha power of STN neuronal activity under different anesthesia regimens (delta: β = 2.64, p < 0.01; theta: β = 2.11, p < 0.01; alpha: β = 1.42, p = 0.01). There were no differences in modified burst index, firing rate, tract numbers of microelectrode recording, and other clinical outcomes between the two groups. Conclusion Optimized propofol anesthesia enhanced the delta, theta, and alpha power in STN compared with the awake technique and likely contributed to target recognition under propofol anesthesia. These results demonstrate that propofol is suitable, but needs to be optimized, for asleep STN-DBS. Trial Registration Chinese Clinical Trial Registry Identification number: ChiCTR2100045942. Registered 29 April 2021–Retrospectively registered Supplementary Information The online version contains supplementary material available at 10.1007/s40120-021-00259-y.
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Affiliation(s)
- Nan Jiang
- Department of Anesthesiology, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Yu-Ting Ling
- Department of Anesthesiology, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Chao Yang
- Department of Neurosurgery, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Yi Liu
- Department of Anesthesiology, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Wen-Biao Xian
- Department of Neurology, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Li-Nan Zhang
- Department of Anesthesiology, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Qian-Qian Guo
- Department of Anesthesiology, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Xing-Yi Jin
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, 518060, Guangdong Province, People's Republic of China
| | - Bin Wu
- Department of Neurosurgery, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Chang-Ming Zhang
- Department of Neurosurgery, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Ling Chen
- Department of Neurology, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Zhi-Guo Zhang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, 518060, Guangdong Province, People's Republic of China
| | - Jin-Long Liu
- Department of Neurosurgery, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China.
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Abbas M, Weedle RC, Soo AW. Surgical management of lung cancer in patient with deep brain stimulator: a challenge for safe hemostasis. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.19.05013-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Park YS, Kim J, Kim SH, Moon YJ, Kwon HM, Park HS, Kim WJ, Ha S. Comparison of recovery profiles in patients with Parkinson's disease for 2 types of neuromuscular blockade reversal agent following deep brain stimulator implantation. Medicine (Baltimore) 2019; 98:e18406. [PMID: 31876713 PMCID: PMC6946526 DOI: 10.1097/md.0000000000018406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
As an anesthetic reversal agent, there are concerns with cholinesterase inhibitors regarding worsening of Parkinson's disease (PD)-related symptoms. Sugammadex, a relatively new reversal agent, does not inhibit acetylcholinesterase and does not require co-administration of an antimuscarinic agent. The present study compared the recovery profiles of 2 agents initially administered for reversal of neuromuscular blockade in patients with advanced PD who underwent deep brain stimulator implantation.A total of 121 patients with PD who underwent deep brain stimulator implantation were retrospectively analyzed. Patients were divided into 1 of 2 groups according to the type of neuromuscular blockade reversal agent (pyridostigmine vs sugammadex) initially administered. Recovery profiles reflecting time to extubation, reversal failure at first attempt, and hemodynamic stability, including incidence of hypertension or tachycardia during the emergence period, were compared.Time to extubation in the sugammadex group was significantly shorter (P < .001). In the sugammadex group, reversal failure at first attempt did not occur in any patient, while it occurred in seven (9.7%) patients in the pyridostigmine group (P = .064), necessitating an additional dose of pyridostigmine (n = 3) or sugammadex (n = 4). The incidence of hemodynamic instability during anesthetic emergence was significantly lower in the sugammadex group than in the pyridostigmine group (P = .019).Sugammadex yielded a recovery profile superior to that of pyridostigmine during the anesthesia emergence period in advanced PD patients. Sugammadex is also likely to be associated with fewer adverse effects than traditional reversal agents, which in turn would also improve overall postoperative management in this patient population.
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Affiliation(s)
- Yong-Seok Park
- Department of Anesthesia and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Jaewon Kim
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Sung-Hoon Kim
- Department of Anesthesia and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Young-Jin Moon
- Department of Anesthesia and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Hye-Mee Kwon
- Department of Anesthesia and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Hee-Sun Park
- Department of Anesthesia and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Wook-Jong Kim
- Department of Anesthesia and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Seungil Ha
- Department of Anesthesia and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
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Bos MJ, Alzate Sanchez AM, Smeets AYJM, Bancone R, Ackermans L, Absalom AR, Buhre WF, Roberts MJ, Janssen MLF. Effect of Anesthesia on Microelectrode Recordings during Deep Brain Stimulation Surgery in Tourette Syndrome Patients. Stereotact Funct Neurosurg 2019; 97:225-231. [PMID: 31707386 DOI: 10.1159/000503691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 09/25/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) is an accepted treatment for patients with medication-resistant Tourette syndrome (TS). Sedation is commonly required during electrode implantation to attenuate anxiety, pain, and severe tics. Anesthetic agents potentially impair the quality of microelectrode recordings (MER). Little is known about the effect of these anesthetics on MER in patients with TS. We describe our experience with different sedative regimens on MER and tic severity in patients with TS. METHODS The clinical records of all TS patients who underwent DBS surgery between 2010 and 2018 were reviewed. Demographic data, stimulation targets, anesthetic agents, perioperative complications, and MER from each hemisphere were collected and analyzed. Single-unit activity was identified by filtering spiking activity from broadband MER data and principal component analysis with K-means clustering. Vocal and motor tics which caused artifacts in the MER data were manually selected using visual and auditory inspection. RESULTS Six patients underwent bilateral DBS electrode implantation. In all patients, the target was the anterior internal globus pallidus. Patient comfort and hemodynamic and respiratory stability were maintained with conscious sedation with one or more of the following anesthetic drugs: propofol, midazolam, remifentanil, clonidine, and dexmedetomidine. Good quality MER and clinical testing were obtained in 9 hemispheres of 6 patients. In 3 patients, MER quality was poor on one side. CONCLUSION Cautiously applied sedative drugs can provide patient comfort, hemodynamic and respiratory stability, and suppress severe tics, with minimal interference with MER.
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Affiliation(s)
- Michael J Bos
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands, .,School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands,
| | - Ana Maria Alzate Sanchez
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Anouk Y J M Smeets
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Raffaella Bancone
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Linda Ackermans
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Anthony R Absalom
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wolfgang F Buhre
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Mark J Roberts
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Marcus L F Janssen
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Neurology and Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
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Stultiens JJA, Postma AA, Guinand N, Pérez Fornos A, Kingma H, van de Berg R. Vestibular Implantation and the Feasibility of Fluoroscopy-Guided Electrode Insertion. Otolaryngol Clin North Am 2019; 53:115-126. [PMID: 31677739 DOI: 10.1016/j.otc.2019.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Recent research has shown promising results for the development of a clinically feasible vestibular implant in the near future. However, correct electrode placement remains a challenge. It was shown that fluoroscopy was able to visualize the semicircular canal ampullae and electrodes, and guide electrode insertion in real time. Ninety-four percent of the 18 electrodes were implanted correctly (<1.5 mm distance to target). The median distances were 0.60 mm, 0.85 mm, and 0.65 mm for the superior, lateral, and posterior semicircular canal, respectively. These findings suggest that fluoroscopy can significantly improve electrode placement during vestibular implantation.
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Affiliation(s)
- Joost Johannes Antonius Stultiens
- Department of Otorhinolaryngology-Head and Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, P.O. box 5800, 6202 AZ, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alida Annechien Postma
- Department of Radiology and Nuclear Medicine, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, P.O. box 5800, 6202 AZ, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nils Guinand
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Angélica Pérez Fornos
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Hermanus Kingma
- Department of Otorhinolaryngology-Head and Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, P.O. box 5800, 6202 AZ, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Raymond van de Berg
- Department of Otorhinolaryngology-Head and Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, P.O. box 5800, 6202 AZ, Maastricht University Medical Center, Maastricht, The Netherlands.
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Klempíř O, Krupička R, Jech R. Microelectrode Neuronal Activity of the Internal Globus Pallidus in Dystonia Correlates with Postoperative Neuromodulation Effects and Placement of the Stimulation Electrode. Ing Rech Biomed 2019. [DOI: 10.1016/j.irbm.2019.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Jiang W, Rajguru SM. Eye Movements Evoked by Pulsed Infrared Radiation of the Rat Vestibular System. Ann Biomed Eng 2018; 46:1406-1418. [PMID: 29845411 PMCID: PMC6095805 DOI: 10.1007/s10439-018-2059-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 05/24/2018] [Indexed: 10/16/2022]
Abstract
Light at infrared wavelengths has been demonstrated to modulate the pattern of neural signals transmitted from the angular motion sensing semicircular canals of the vestibular system to the brain. In the present study, we have characterized physiological eye movements evoked by focused, pulsed infrared radiation (IR) stimuli directed at an individual semicircular canal in a mammalian model. Pulsed IR (1863 nm) trains were directed at the posterior semicircular canal in a rat using 200-400 µm optical fibers. Evoked bilateral eye movements were measured using a custom-modified video-oculography system. The activation of vestibulo-ocular motor pathways by frequency modulated pulsed IR directed at single posterior semicircular canals evoked significant, characteristic bilateral eye movements. In this case, the resulting eye movements were disconjugate with ipsilateral eye moving upwards with a rotation towards the stimulated ear and the contralateral eye moving downwards. The eye movements were stable through several hours of repeated stimulation and could be maintained with 30 + minutes of continuous, frequency-modulated IR stimulation. Following the measurements, the distance of the fiber from target structures and orientation of the beam relative to vestibular structures were determined using micro-computed tomography. Results highlight the spatial selectivity of optical stimulation. Our results demonstrate a novel strategy for direct optical stimulation of the vestibular pathway in rodents and lays the groundwork for future applications of optical neural stimulation in inner ear research and therapeutic applications.
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Affiliation(s)
- Weitao Jiang
- Department of Biomedical Engineering, University of Miami, 1251 Memorial Drive, MEA 204, Coral Gables, FL, 33146, USA
| | - Suhrud M Rajguru
- Department of Biomedical Engineering, University of Miami, 1251 Memorial Drive, MEA 204, Coral Gables, FL, 33146, USA.
- Department of Otolaryngology, University of Miami, 1600 NW 10th Ave, RMSB 3160, Miami, FL, 33136, USA.
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Özlü O. Anaesthesiologist's Approach to Awake Craniotomy. Turk J Anaesthesiol Reanim 2018; 46:250-256. [PMID: 30140530 DOI: 10.5152/tjar.2018.56255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/13/2018] [Indexed: 12/29/2022] Open
Abstract
Awake craniotomy, which was initially used for the surgical treatment of epilepsy, is performed for the resection of tumours in the vicinity of some eloquent areas of the cerebral cortex which is essential for language and motor functions. It is also performed for stereotactic brain biopsy, ventriculostomy, and supratentorial tumour resections. In some institutions, avoiding risks of general anaesthesia, shortened hospitalization and reduced use of hospital resources may be the other indications for awake craniotomy. Anaesthesiologists aim to provide safe and effective surgical status, maintaining a comfortable and pain-free condition for the patient during surgical procedure and prolonged stationary position and maintaining patient cooperation during intradural interventions. Providing anaesthesia for awake craniotomy require scalp blockage, specific sedation protocols and airway management. Long-acting local anaesthetic agents like bupivacaine or levobupivacaine are preferred. More commonly, propofol, dexmedetomidine and remifentanyl are used as sedative agents. A successful anaesthesia for awake craniotomy depends on the personal experience and detailed planning of the anaesthetic procedure. The aim of this review was to present an anaesthetic technique for awake craniotomy under the light of the literature.
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Affiliation(s)
- Onur Özlü
- Department of Anaesthesiology and Reanimation, TOBB University of Economics and Technology, Ankara, Turkey
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Blandford AD, Wiggins NB, Ansari W, Hwang CJ, Wilkoff BL, Perry JD. Cautery selection for oculofacial plastic surgery in patients with implantable electronic devices. Eur J Ophthalmol 2018; 29:315-322. [PMID: 29998777 DOI: 10.1177/1120672118787440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To discover oculofacial plastic surgeon practice patterns for cautery selection in the setting of implantable electronic devices and present guidelines based on a review of current literature. METHODS A 10-Question web-based survey was sent to the email list serve of the American Society of Ophthalmic Plastic and Reconstructive Surgery to determine surgeon cautery preference in the setting of various implantable electronic devices and comfort level with the guidelines for cautery selection in their practice or institution. The relationship between survey questions was assessed for statistical significance using Pearson's Chi-square tests. RESULTS Two hundred ninety-three (41% response rate) surveys were completed and included for analysis. Greater than half of respondents either had no policy (36%) or were unaware of a policy (19%) in their practice or institution regarding cautery selection in patients with a cardiac implantable electronic device. Bipolar cautery was favored for use in patients with a cardiac implantable electronic device (79%-80%) and this number dropped in patients with implantable neurostimulators (30%). Overall, one-third of respondents did not feel comfortable with their practice/institution policy. CONCLUSION Choices and comfort level among oculofacial plastic surgeons for cautery selection in patients with implantable electronic devices vary considerably, and some choices may increase the risk for interference-related complications. Practice patterns vary significantly in the setting of a neurostimulator or cochlear implant, where interference can cause thermal injury to the brain and implant damage, respectively. Guidelines are proposed for cautery selection in patients with implantable electronic devices undergoing oculofacial plastic surgery.
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Affiliation(s)
| | - Newton B Wiggins
- 2 Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Waseem Ansari
- 1 Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Catherine J Hwang
- 1 Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Bruce L Wilkoff
- 2 Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Julian D Perry
- 1 Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Wong EH, Oh LJ, Parker DA. Outcomes of Primary Total Knee Arthroplasty in Patients With Parkinson's Disease. J Arthroplasty 2018; 33:1745-1748. [PMID: 29576489 DOI: 10.1016/j.arth.2018.02.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 01/26/2018] [Accepted: 02/05/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Parkinson's disease is a degenerative disorder causing rigidity, bradykinesia, and tremor of the motor system. There is significant paucity of evidence regarding whether total knee arthroplasty (TKA) is of benefit in patients with both Parkinson's disease and osteoarthritis. We aimed to compare outcomes and complications of TKA between patients with Parkinson's disease and those without. METHODS A cohort of 43 knees from 35 patients with Parkinson's disease who received a primary TKA between January 2004 and December 2015 were retrospectively extracted from a private clinical database held by 2 surgeons and compared to an age and gender-matched control group of 50 knees from 41 patients. TKAs were performed by 2 surgeons at 1 tertiary private hospital.The indication for TKA in both groups was osteoarthritis. Difference between preoperative and 1-year range of movement (ROM) and 12-point Oxford Knee Score (OKS) was assessed using Student's unpaired t-test. Postoperative complications and revision procedures were also recorded during the follow-up period. The minimal clinically important difference for OKS at 1-year follow-up, defined as improvement of ≥6, was also assessed. RESULTS In the Parkinson's group, mean ROM improvement was 14° (100° preoperatively to 114° at 12 months), compared to 12° in the control group (102°-114°, respectively). Mean OKS improvement was 15 in the Parkinson's group (23 preoperatively to 38 at 12 months) compared to 17 in the control group (23 and 40, respectively.) No significant difference was identified between the 2 groups for either ROM (P = .96) or OKS (P = .45.) All Parkinson's patients achieved the minimal clinically important difference at 1-year follow-up. There were no mortalities during the study follow-up period and no significant difference in complication rates between the 2 groups (P = .41). CONCLUSION Parkinson's disease was not associated with poorer functional outcomes or increased complications compared to controls in our study. We suggest that Parkinson's disease is not an absolute contraindication to TKA.
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Affiliation(s)
- Eugene H Wong
- Department of Orthopedic Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia; Sydney Orthopaedic Research Institute, Chatswood, New South Wales, Australia
| | - Lawrence J Oh
- Department of Orthopedic Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - David A Parker
- Department of Orthopedic Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia; Sydney Orthopaedic Research Institute, Chatswood, New South Wales, Australia
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Simma L, Fontana M, Schmitt-Mechelke T. Resuscitation of a Patient With an Implanted Electronic Device. Ann Emerg Med 2018; 71:467-469. [DOI: 10.1016/j.annemergmed.2017.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Indexed: 11/24/2022]
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Functional Brain Surgery (Stereotactic Surgery, Deep Brain Stimulation). Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Remifentanil Requirement for Inhibiting Responses to Tracheal Intubation and Skin Incision Is Reduced in Patients With Parkinson's Disease Undergoing Deep Brain Stimulator Implantation. J Neurosurg Anesthesiol 2017; 28:303-8. [PMID: 26368663 DOI: 10.1097/ana.0000000000000229] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is a common neurodegenerative disease affecting the quality of life in the elderly. We speculated that PD patients might have abnormal pharmacodynamics due to the degenerative neural system, and the present study was performed to investigate the pharmacodynamics of remifentanil in PD patients. MATERIALS AND METHODS Two arms of patients were recruited, including 31 PD patients undergoing pulse generator placement after deep brain stimulator implantation and 31 pair-controlled patients undergoing intracranial surgery without PD (NPD). Patients were anesthetized with target-controlled infusion of propofol and remifentanil. The effective concentration of remifentanil to inhibit responses to intubation and skin incision in 50% and 95% patients (EC50 and EC95) was determined by the up and down method. RESULTS Demographic data, bispectral index, and hemodynamic values were similar between the PD and the NPD groups. The average remifentanil concentration used in the PD group for tracheal intubation is significantly lower than in the NPD group (P<0.001). The EC50 for inhibiting the response to tracheal intubation were 1.86 ng/mL (95% confidential interval [CI], 1.77-1.96 ng/mL) in the PD group and 3.20 ng/mL (95% CI, 3.13-3.27 ng/mL) in the NPD group. The average remifentanil concentration used in the PD group for skin incision is significantly lower than in the NPD group (P<0.001). EC50 for inhibiting the response to skin incision were 2.17 ng/mL (95% CI, 2.09-2.25 ng/mL) in the PD group and 3.09 ng/mL (95% CI, 3.02-3.17 ng/mL) in the NPD group. CONCLUSIONS The remifentanil concentrations required for inhibiting responses to tracheal intubation and skin incision are reduced markedly in PD patients undergoing pulse generator placement (NCT01992692).
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Larson PS, Willie JT, Vadivelu S, Azmi-Ghadimi H, Nichols A, Fauerbach LL, Johnson HB, Graham D. MRI-guided stereotactic neurosurgical procedures in a diagnostic MRI suite: Background and safe practice recommendations. J Healthc Risk Manag 2017; 37:31-39. [PMID: 28719087 DOI: 10.1002/jhrm.21275] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The development of navigation technology facilitating MRI-guided stereotactic neurosurgery has enabled neurosurgeons to perform a variety of procedures ranging from deep brain stimulation to laser ablation entirely within an intraoperative or diagnostic MRI suite while having real-time visualization of brain anatomy. Prior to this technology, some of these procedures required multisite workflow patterns that presented significant risk to the patient during transport. For those facilities with access to this technology, safe practice guidelines exist only for procedures performed within an intraoperative MRI. There are currently no safe practice guidelines or parameters available for facilities looking to integrate this technology into practice in conventional MRI suites. Performing neurosurgical procedures in a diagnostic MRI suite does require precautionary measures. The relative novelty of technology and workflows for direct MRI-guided procedures requires consideration of safe practice recommendations, including those pertaining to infection control and magnet safety issues. This article proposes a framework of safe practice recommendations designed for assessing readiness and optimization of MRI-guided neurosurgical interventions in the diagnostic MRI suite in an effort to mitigate patient risk. The framework is based on existing clinical evidence, recommendations, and guidelines related to infection control and prevention, health care-associated infections, and magnet safety, as well as the clinical and practical experience of neurosurgeons utilizing this technology.
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Affiliation(s)
| | - Jon T Willie
- Emory University Department of Neurosurgery in Atlanta, Georgia
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Individualized Anesthetic Management for Patients Undergoing Electroconvulsive Therapy. Anesth Analg 2017; 124:1943-1956. [DOI: 10.1213/ane.0000000000001873] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Mathews L, Camalier CR, Kla KM, Mitchell MD, Konrad PE, Neimat JS, Smithson KG. The Effects of Dexmedetomidine on Microelectrode Recordings of the Subthalamic Nucleus during Deep Brain Stimulation Surgery: A Retrospective Analysis. Stereotact Funct Neurosurg 2017; 95:40-48. [PMID: 28132061 DOI: 10.1159/000453326] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 10/18/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The placement of subthalamic nucleus (STN) deep brain stimulation (DBS) electrodes can be facilitated by intraoperative microelectrode recording (MER) of the STN. OBJECTIVES Optimal anesthetic management during surgery remains unclear because of a lack of quantitative data of the effect of anesthetics on MER. Therefore, we measured the effects of dexmedetomidine (DEX) on MER measures of the STN commonly taken intraoperatively. METHODS MER from 45 patients was retrospectively compared between patients treated with remifentanil (REMI) alone or both REMI and DEX, which are the 2 main standards of care at our center. The measures examined were population activity, such as root mean square, STN length, and number of passes yielding STN, and the single-neuron measures of firing rate and variability. RESULTS The addition of DEX does not affect population measures (number of passes: DEX+REMI, n = 68, REMI only, n = 154), or neuronal firing rates (number of neurons: DEX+REMI, n = 64, REMI only, n = 72), but firing rate variability was reduced. CONCLUSIONS In this cohort, population-based measures routinely used for electrode placement in the STN were unaffected by DEX when added to REMI. Neuronal firing rates were also unaffected, but their variability was reduced, even beyond 20 min after cessation.
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Affiliation(s)
- Letha Mathews
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
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Dhar M, Sreevastava DK, Gupta N, Mishra S. Choice of sedative for deep brain stimulation in Parkinson’s disease: Our experience and comparison of two cases. EGYPTIAN JOURNAL OF ANAESTHESIA 2017. [DOI: 10.1016/j.egja.2016.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Mridul Dhar
- Department of Anaesthesiology and Critical Care, Army Hospital (Research & Referral), New Delhi, India
| | - Deepak Kumar Sreevastava
- Department of Anaesthesiology and Critical Care, Army Hospital (Research & Referral), New Delhi, India
| | - Nitish Gupta
- Department of Anaesthesiology and Critical Care, Army Hospital (Research & Referral), New Delhi, India
| | - Somya Mishra
- Department of Anaesthesiology and Critical Care, Army Hospital (Research & Referral), New Delhi, India
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Yeoh TY, Manninen P, Kalia SK, Venkatraghavan L. Anesthesia considerations for patients with an implanted deep brain stimulator undergoing surgery: a review and update. Can J Anaesth 2016; 64:308-319. [DOI: 10.1007/s12630-016-0794-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 10/06/2016] [Accepted: 12/08/2016] [Indexed: 11/25/2022] Open
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Cortical Arousal With Deep Brain Stimulation After General Anesthesia for Laparoscopic Cholecystectomy. J Neurosurg Anesthesiol 2016; 30:77-78. [PMID: 27851692 DOI: 10.1097/ana.0000000000000389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Whitney PS, Sturgess J. Anaesthetic considerations for patients with neurosurgical implants. BJA Educ 2016. [DOI: 10.1093/bjaed/mkv049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Weinstein AS, Aglio LS. Preanesthetic evaluation of a patient with a deep brain stimulator: a practical guide and checklist for patient safety. J Clin Anesth 2016; 31:278-81. [PMID: 27185727 DOI: 10.1016/j.jclinane.2016.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 01/05/2016] [Accepted: 02/08/2016] [Indexed: 11/26/2022]
Abstract
As the patient population with deep brain stimulators grows, medical personnel need to be comfortable managing these patients because they will likely encounter them in practice. Caring for a patient with a deep brain stimulator during surgery or a procedure requires technical knowledge of the device and its possible interactions in order to take the correct precautionary measures. Here we discuss the key issues and questions that should be covered in every preanesthetic evaluation visit of a patient with a deep brain stimulator along with an evaluation checklist.
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Affiliation(s)
- Adam S Weinstein
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis St, CWN-L1 Boston, MA 02115 USA.
| | - Linda S Aglio
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis St, CWN-L1 Boston, MA 02115 USA.
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Abstract
Technology is the prominent feature of the twenty-first century, including in medicine. There are very few organs that cannot be stimulated, shocked, or infused. With more and more implantable devices being approved for clinical use, anesthesiologists have to regularly take care of patients who have these devices. An understanding of the devices, the associated comorbidities, and the perioperative risks is crucial for safe management of these patients. Cardiac devices are discussed in some detail; neurostimulators and other implantable devices are briefly described. The principles of assessment and management are similar for all patients with implanted devices.
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Affiliation(s)
- Ana Costa
- Department of Anesthesiology, Stony Brook Medicine, 101 Nicolls Road, Stony Brook, NY 11794-8480, USA.
| | - Deborah C Richman
- Department of Anesthesiology, Stony Brook Medicine, 101 Nicolls Road, Stony Brook, NY 11794-8480, USA
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Scharpf DT, Sharma M, Deogaonkar M, Rezai A, Bergese SD. Practical considerations and nuances in anesthesia for patients undergoing deep brain stimulation implantation surgery. Korean J Anesthesiol 2015; 68:332-9. [PMID: 26257844 PMCID: PMC4524930 DOI: 10.4097/kjae.2015.68.4.332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 12/18/2014] [Accepted: 12/22/2014] [Indexed: 12/02/2022] Open
Abstract
The field of functional neurosurgery has expanded in last decade to include newer indications, new devices, and new methods. This advancement has challenged anesthesia providers to adapt to these new requirements. This review aims to discuss the nuances and practical issues that are faced while administering anesthesia for deep brain stimulation surgery.
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Affiliation(s)
- Danielle Teresa Scharpf
- Department of Neuroanestheisa, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, OH, USA
| | - Mayur Sharma
- Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, OH, USA
| | - Milind Deogaonkar
- Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, OH, USA
| | - Ali Rezai
- Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, OH, USA
| | - Sergio D Bergese
- Department of Neuroanestheisa, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, OH, USA
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Khetarpal M, Yadav M, Kulkarni D, Gopinath R. Anaesthetic management of a patient with deep brain stimulation implant for radical nephrectomy. Indian J Anaesth 2014; 58:461-3. [PMID: 25197118 PMCID: PMC4155295 DOI: 10.4103/0019-5049.139009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A 63-year-old man with severe Parkinson's disease (PD) who had been implanted with deep brain stimulators into both sides underwent radical nephrectomy under general anaesthesia with standard monitoring. Deep brain stimulation (DBS) is an alternative and effective treatment option for severe and refractory PD and other illnesses such as essential tremor and intractable epilepsy. Anaesthesia in the patients with implanted neurostimulator requires special consideration because of the interaction between neurostimulator and the diathermy. The diathermy can damage the brain tissue at the site of electrode. There are no standard guidelines for the anaesthetic management of a patient with DBS electrode in situ posted for surgery.
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Affiliation(s)
- Monica Khetarpal
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Monu Yadav
- Department of Anaesthesiology and Critical Care, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
| | - Dilip Kulkarni
- Department of Anaesthesiology and Critical Care, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
| | - R Gopinath
- Department of Anaesthesiology and Critical Care, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
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Hippard HK, Watcha M, Stocco AJ, Curry D. Preservation of microelectrode recordings with non-GABAergic drugs during deep brain stimulator placement in children. J Neurosurg Pediatr 2014; 14:279-86. [PMID: 24995822 DOI: 10.3171/2014.5.peds13103] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT 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.
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Bendersky D, Ajler P, Yampolsky C. [The use of neuromodulation for the treatment of tremor]. Surg Neurol Int 2014; 5:S232-46. [PMID: 25165613 PMCID: PMC4138824 DOI: 10.4103/2152-7806.137944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 11/29/2012] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Tremor may be a disabling disorder and pharmacologic treatment is the first-line therapy for these patients. Nevertheless, this treatment may lead to a satisfactory tremor reduction in only 50% of patients with essential tremor. Thalamotomy was the treatment of choice for tremor refractory to medical therapy until deep brain stimulation (DBS) of the ventral intermedius nucleus (Vim) of the thalamus has started being used. Nowadays, thalamotomy is rarely performed. METHODS This article is a non-systematic review of the indications, results, programming parameters and surgical technique of DBS of the Vim for the treatment of tremor. RESULTS In spite of the fact that it is possible to achieve similar clinical results using thalamotomy or DBS of the Vim, the former causes more adverse effects than the latter. Furthermore, DBS can be used bilaterally, whereas thalamotomy has a high risk of causing disartria when it is performed in both sides. DBS of the Vim achieved an adequate tremor improvement in several series of patients with tremor caused by essential tremor, Parkinson's disease or multiple sclerosis. Besides the Vim, there are other targets, which are being used by some authors, such as the zona incerta and the prelemniscal radiations. CONCLUSION DBS of the Vim is a useful treatment for disabling tremor refractory to medical therapy. It is essential to carry out an accurate patient selection as well as to use a proper surgical technique. The best stereotactic target for tremor is still unknown, although the Vim is the most used one.
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Affiliation(s)
- Damián Bendersky
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Pablo Ajler
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Claudio Yampolsky
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
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Gandhi R, Chawla R. Anaesthetic management of shoulder arthroscopic repair in Parkinson's disease with deep brain stimulator. Indian J Anaesth 2014; 58:309-11. [PMID: 25024475 PMCID: PMC4090998 DOI: 10.4103/0019-5049.135044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We describe the anaesthetic management of arthroscopic repair for complete rotator cuff tear of shoulder in a 59-year-old female with Parkinson's disease (PD) with deep brain stimulator (DBS) using a combination of general anaesthesia with interscalene approach to brachial plexus block. The DBS consists of implanted electrodes in the brain connected to the implantable pulse generator (IPG) normally placed in the anterior chest wall subcutaneously. It can be programmed externally from a hand-held device placed directly over the battery stimulator unit. In our patient, IPG with its leads was located in close vicinity of the operative site with potential for DBS malfunction. Implications of DBS in a patient with PD for shoulder arthroscopy for anaesthesiologist are discussed along with a brief review of DBS.
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Affiliation(s)
- Ranju Gandhi
- Department of Anaesthesia and Intensive Care and Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | - Reeta Chawla
- Department of Anaesthesia and Intensive Care and Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
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Andres DS, Cerquetti D, Merello M, Stoop R. Neuronal Entropy Depends on the Level of Alertness in the Parkinsonian Globus Pallidus in vivo. Front Neurol 2014; 5:96. [PMID: 25009529 PMCID: PMC4069479 DOI: 10.3389/fneur.2014.00096] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 05/31/2014] [Indexed: 12/02/2022] Open
Abstract
A new working hypothesis of Parkinson's disease (PD) proposes to focus on the central role of entropy increase in the basal ganglia (BG) in movement disorders. The conditions necessary for entropy increase in vivo are, however, still not fully described. We recorded the activity of single globus pallidus pars interna neurons during the transition from deep anesthesia to full alertness in relaxed, head-restrained, control, and parkinsonian (6-hydroxydopamine-lesioned group-lesioned) rats. We found that during awakening from anesthesia, the variation of neuronal entropy was significantly higher in the parkinsonian than in the control group. This implies in our view that in PD the entropy of the output neurons of the BG varies dynamically with the input to the network, which is determined by the level of alertness. Therefore, entropy needs to be interpreted as a dynamic, emergent property that characterizes the global state of the BG neuronal network, rather than a static property of parkinsonian neurons themselves. Within the framework of the "entropy hypothesis," this implies the presence of a pathological feedback loop in the parkinsonian BG, where increasing the network input results in a further increase of neuronal entropy and a worsening of akinesia.
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Affiliation(s)
- Daniela Sabrina Andres
- Institute of Neuroinformatics, ETH Zurich and University of Zurich, Zurich, Switzerland
- Movement Disorders Section, Institute for Neurological Research Raul Carrea, Fleni Institute, Buenos Aires, Argentina
- Society in Science, The Branco-Weiss Fellowship, ETH Zurich, Zurich, Switzerland
| | - Daniel Cerquetti
- Movement Disorders Section, Institute for Neurological Research Raul Carrea, Fleni Institute, Buenos Aires, Argentina
| | - Marcelo Merello
- Movement Disorders Section, Institute for Neurological Research Raul Carrea, Fleni Institute, Buenos Aires, Argentina
| | - Ruedi Stoop
- Institute of Neuroinformatics, ETH Zurich and University of Zurich, Zurich, Switzerland
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Seemann M, Zech N, Lange M, Hansen J, Hansen E. [Anesthesiological aspects of deep brain stimulation : special features of implementation and dealing with brain pacemaker carriers]. Anaesthesist 2014; 62:549-56. [PMID: 23817843 DOI: 10.1007/s00101-013-2201-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Deep brain stimulation (DBS) provides a very effective treatment for a number of neurological diseases including Parkinson's disease, movement disorders and epilepsy. In DBS microelectrodes are positioned in defined cerebral target areas and connected to a pacemaker. It is most often performed as an awake craniotomy with intraoperative testing. Various anesthesiological regimes are used to protect the patient from surgical stress on the one hand and to achieve ideal test conditions on the other. They include local anesthesia or scalp blocks, intermittent general anesthesia or analgosedation with or without airway protection; however, anesthetic agents interfere with hemodynamic stability and ventilation, with vigilance and cooperation and in addition with the symptoms and microelectrode recording. Guidance and communication have a pivotal impact on patient needs for pharmacological interventions. With increasing numbers of DBS procedures, anesthesiologists are more often faced with patients carrying brain pacemakers. For anesthesia the characteristics of the disease as well as the respective long-term medication have to be considered. In addition, the rules for handling patients with pacemakers need to be followed to avoid both dysfunction of the generator and tissue damage due to overheating of the electrodes.
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Affiliation(s)
- M Seemann
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, 93042, Regensburg, Deutschland
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Slotty PJ, Wille C, Kinfe TM, Vesper J. Continuous perioperative apomorphine in deep brain stimulation surgery for Parkinson's disease. Br J Neurosurg 2013; 28:378-82. [PMID: 24073755 DOI: 10.3109/02688697.2013.841859] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with Parkinson's disease (PD) deprived of dopaminergic medication to facilitate awake testing during the deep brain stimulation (DBS) procedure are at increased risk of neurologic deterioration.. The aim of this survey was to demonstrate the safety of subcutaneous apomorphine treatment for reducing surgery-related neurologic deterioration in patients undergoing DBS surgery for PD. METHODS Ninety-two patients who underwent DBS surgery for PD between 11/2007 and 10/2011 in our department were retrospectively analyzed for this survey. Demographic data, apomorphine dosage, side-effects and need of ICU/IMC stay were collected and analyzed. RESULTS Seventy-two out of 92 patients (78.3%) received apomorphine treatment; main reason for omission of treatment was intolerable nausea (16/92, 17.3%). Apomorphine treatment was well tolerated and the most common side effect was nodular panniculitis. No severe complications were observed. No patient required ICU/IMC stay related to dopaminergic deprivation. CONCLUSIONS Perioperative withdrawal of dopaminergic medication in PD patients leads to an increased risk of neurologic and respiratory deterioration during DBS procedures. These complications can likely be tempered using perioperative subcutaneous apomorphine as a substitute. Our 5-year experience indicates a reduction in postoperative neurologic deterioration and ICU/IMC stay need. We consider perioperative apomorphine safe during DBS surgery for PD.
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Karimi A, Conti JB, Beaver TM. Implantation of a cardiac resynchronization therapy defibrillator in a patient with bilateral deep brain stimulator: feasibility and technique. J Interv Card Electrophysiol 2012; 35:351-3; discussion 353. [PMID: 23011386 DOI: 10.1007/s10840-012-9718-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 07/23/2012] [Indexed: 11/26/2022]
Abstract
Uncommonly, a patient with a NeuroStimulator Device (NSD) for a neurologic indication requires a cardiovascular implantable electronic device (CIED) for a cardiac indication. Typically in those with a unilateral pectoral NSD, the contralateral pectoral space is used for CIED implantation; however, in very rare occasions the patient has bilateral pectoral NSDs which makes subsequent implantation of a CIED challenging both because of placement and device interaction. Herein, we introduce the case of a 68-year-old gentleman with bilateral pectoral deep brain stimulators for Parkinsonism who received cardiac resynchronization therapy-defibrillator (CRT-D) for advanced heart failure. The CRT-D generator was implanted in the abdomen and the CRT-D leads were placed through a minimally invasive epicardial approach. Both devices were tested without any evidence of device interaction.
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Affiliation(s)
- Ashkan Karimi
- Department of Medicine, University of Florida, Gainesville, FL 32610-0129, USA
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Erickson KM, Cole DJ. Anesthetic considerations for awake craniotomy for epilepsy and functional neurosurgery. Anesthesiol Clin 2012; 30:241-268. [PMID: 22901609 DOI: 10.1016/j.anclin.2012.05.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The two most common neurosurgical procedures that call for an awake patient include epilepsy surgery and functional neurosurgery. Monitoring patients in the awake state allows more aggressive resection of epileptogenic foci in functionally important brain regions. Careful patient selection and preparation combined with attentive monitoring and anticipation of events are fundamental to a smooth awake procedure. Current pharmacologic agents and techniques at the neuroanesthesiologist's disposal facilitate an increasing number of procedures performed in awake patients.
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Affiliation(s)
- Kirstin M Erickson
- Department of Anesthesiology, Mayo Clinic College of Medicine, 200 First Street SE, Rochester, MN 55901, USA.
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Canadian Cardiovascular Society/Canadian Anesthesiologists' Society/Canadian Heart Rhythm Society Joint Position Statement on the Perioperative Management of Patients With Implanted Pacemakers, Defibrillators, and Neurostimulating Devices. Can J Cardiol 2012; 28:141-51. [DOI: 10.1016/j.cjca.2011.08.121] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 08/20/2011] [Accepted: 08/21/2011] [Indexed: 11/18/2022] Open
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van de Berg R, Guinand N, Guyot JP, Kingma H, Stokroos RJ. The modified ampullar approach for vestibular implant surgery: feasibility and its first application in a human with a long-term vestibular loss. Front Neurol 2012; 3:18. [PMID: 22363317 PMCID: PMC3282298 DOI: 10.3389/fneur.2012.00018] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Accepted: 01/30/2012] [Indexed: 11/13/2022] Open
Abstract
Objective: To assess, for the first time in a human with a long-term vestibular loss, a modified approach to the ampullae and the feasibility of evoking a VOR by ampullar stimulation. Materials and methods: Peroperative stimulation of the ampullae, using the ampullar approach, was performed under full anesthesia during cochlear implantation in a 21-year-old female patient, who had experienced bilateral vestibular areflexia and sensorineural hearing loss for almost 20 years. Results: The modified ampullar approach was performed successfully with as minimally invasive surgery as possible. Ampullar stimulation evoked eye movements containing vectors congruent with the stimulated canal. As expected, the preliminary electrophysiological data were influenced by the general anesthesia, which resulted in current spread and reduced maximum amplitudes of eye movement. Nevertheless, they confirm the feasibility of ampullar stimulation. Conclusion: The modified ampullar approach provides safe access to the ampullae using as minimally invasive surgery as possible. For the first time in a human with long-term bilateral vestibular areflexia, it is shown that the VOR can be evoked by ampullar stimulation, even when there has been no vestibular function for almost 20 years. This approach should be considered in vestibular surgery, as it provides safe access to one of the most favorable stimulus locations for development of a vestibular implant.
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Affiliation(s)
- Raymond van de Berg
- Department of Otolaryngology and Head and Neck Surgery, Maastricht University Medical Centre Maastricht, Netherlands
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Schumacher J, Wille C, Vesper J. Management of postoperative respiratory failure in a patient with acute diaphragmatic status dystonicus. Br J Anaesth 2012; 108:329-30. [DOI: 10.1093/bja/aer468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Chhor V, Karachi C, Bonnet AM, Puybasset L, Lescot T. Anesthésie et maladie de Parkinson. ACTA ACUST UNITED AC 2011; 30:559-68. [DOI: 10.1016/j.annfar.2011.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 02/22/2011] [Indexed: 10/18/2022]
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Guimarães J, Vieira-Coelho A, Rosas MJ, Moura E, Vaz R, Garrett C. Acute renal failure in patients with bilateral deep brain stimulation. Mov Disord 2011; 25:2462-4. [PMID: 20669290 DOI: 10.1002/mds.23228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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