Hemodynamic Perturbations in Deep Brain Stimulation Surgery: First Detailed Description

Incidence of complications associated with deep brain stimulation surgery in patients with Parkinson's disease: An 8-year retrospective study

Background

Various complications occur in patients undergoing deep brain stimulation (DBS) surgery. The objective of this study was to determine the incidence of complications in patients with Parkinson's disease who underwent DBS surgery and identify the risk factors, especially anesthetic factors.

Methods

A retrospective cohort study was performed between May 2015 and December 2022. Based on a review of medical charts, patients aged 18 years or older who underwent DBS surgery at a tertiary neurological center in Thailand were recruited. Univariate analysis using the Chi-square test or Fisher's exact test was performed to compare patients with and without complications. Multivariate logistic regression analysis was performed to identify the predictive factors for complications.

Results

The study included 46 patients. The most common complication during DBS electrode placement was hypertension (30/46, 65.2%), and 19 patients (41.3%) who developed hypertension did not receive antihypertensive treatment. The most common complication during battery placement was clinical hypotension (14/46, 30.4%). The most common postoperative complication was delirium (6/46, 13.0%). In the multivariate analysis, no significant independent risk factors for overall complications after DBS surgery were identified.

Conclusions

Hypertension during DBS electrode insertion was the most common perioperative complication. Hemodynamic instability is preventable and manageable, and vigilant and prompt treatment should be provided during DBS surgery.

Anesthesia for deep brain stimulation: an update

PURPOSE OF REVIEW

Deep brain stimulation (DBS) is a rapidly expanding surgical modality for the treatment of patients with movement disorders. Its ability to be adjusted, titrated, and optimized over time has given it a significant advantage over traditional more invasive surgical procedures. Therefore, the success and popularity of this procedure have led to the discovery of new indications and therapeutic targets as well as advances in surgical techniques. The aim of this review is to highlight the important updates in DBS surgery and to exam the anesthesiologist's role in providing optimal clinical management.

RECENT FINDINGS

New therapeutic indications have a significant implication on perioperative anesthesia management. In addition, new technologies like frameless stereotaxy and intraoperative magnetic resonance imaging to guide electrode placement have altered the need for intraoperative neurophysiological monitoring and hence increased the use of general anesthesia. With an expanding number of patients undergoing DBS implantation, patients with preexisting DBS increasingly require anesthesia for unrelated surgery and the anesthesiologist must be aware of the considerations for perioperative management of these devices and potential complications.

SUMMARY

DBS will continue to grow and evolve requiring adaptation and modification to the anesthetic management of these patients.