Skip to main content

Advertisement

SpringerLink
Log in

General anaesthesia for deep brain stimulator electrode insertion in Parkinson’s disease

  • Clinical Article
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

This paper compares the use of general and local anaesthetic in patients having deep brain stimulator (DBS) surgery. It is a retrospective case note study of 46 patients treated consecutively with subthalamic nucleus stimulation for Parkinson’s disease as practise changed in a Neurosurgical unit.

Methods

The first 20 patients (LA group) had permanent electrodes placed under local anaesthesia. The remaining 26 patients (GA group) had the entire procedure under general anaesthesia. The groups were similar for age, sex, duration of Parkinson’s disease and preoperative levodopa requirement.

Results

The clinical results were similar in that within each group, the reduction in levodopa was not only clinically but also statistically significant (p < 0.001 for both, paired t test): for the LA group, the 6-month requirement was 39.4% (29.5–52.6%) of the preoperative requirement and for the GA group, the 6-month requirement was 32.3% (25.2–41.5%) of the preoperative requirement. The reduction in levodopa was maintained at 1 year. Of note, duration of surgery and length of stay were reduced. The mean duration of surgery was 8.2 h (7.8–8.6) for the LA group and 7.5 h (7.2–7.8) for the GA group (p = 0.003). The geometric mean of length of hospital stay was 5.4 days(4.6–6.3) for the LA group and 3.8 days (3.4–4.4) for the GA group (p = 0.001) There was no difference in electrophysiological recording.

Conclusion

This study describes benefits in the GA group for the entire procedure of STN DBS. In these samples, there was no difference in the adverse effects seen in patients undergoing deep brain stimulator insertion with general anaesthetic compared with local anaesthetic. The use of general anaesthetic did not detract from the known benefits of surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ansell GL, Montogomery JE (2004) Outcome of ASA III patients undergoing day case surgery. Br J Anaesth 92:71–74

    Article  CAS  PubMed  Google Scholar 

  2. Benabid A, Krack P, Benazzouz A, Limousin P, Koudsie A, Pollak P (2000) Deep brain stimulation of the subthalamic nucleus for Parkinson’s disease: methodologic aspects and clinical criteria. Neurology 55(Suppl 6):S40–S44

    CAS  PubMed  Google Scholar 

  3. Burch D, Sheerin F (2005) Parkinson’s disease. Lancet 365:622–627

    PubMed  Google Scholar 

  4. Gan P, Sutcliffe A, Mitchell R, Mocroft P (2005) General anaesthesia is safe for implantation of electrodes in the STN. Br J Neurosurg 19(1):99

    Article  Google Scholar 

  5. Gray H, Wilson S, Sidebottom P (2003) Parkinson’s disease and anaesthesia. Br J Anaesth 90:524

    Article  CAS  PubMed  Google Scholar 

  6. Gregory R (2002) Surgery for movement disorders. J Neurol Neurosurg Psychiatry 72(Suppl 1):i32–i36

    PubMed  Google Scholar 

  7. Guridi J, Rodriguez-Oroz MC, Lozano A, Moro E, Albanese A, Nuttin B, Gybels J, Ramos E, Obeso J (2000) Targeting the basal ganglia for deep brain stimulation in Parkinson’s disease. Neurology 55(Suppl 6):S21–S28

    CAS  PubMed  Google Scholar 

  8. Krack P, Batir A, Van Blercom N, Chabardes S, Fraix V, Ardouin C, Koudsie A, Limousin P, Bennazzouz A, LeBas J, Benabid A, Pollak P (2003) Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N Engl J Med 349:1925–1934

    Article  CAS  PubMed  Google Scholar 

  9. Maltête D, Navarro S, Welter M, Roche S, Bonnet A, Houeto J, Mesnage V, Pidoux B, Dormant D, Cornu P, Agid Y (2004) Subthalamic stimulation in Parkinson disease: with or without anesthesia? Arch Neurol 61:390–392

    Article  PubMed  Google Scholar 

  10. National Institute for Clinical Excellence (2003) Interventional procedure overview of deep brain stimulation in Parkinson’s disease. National Institute for Clinical Excellence, London

    Google Scholar 

  11. Olanow CW, Brin MF, Obeso JA (2000) The role of deep brain stimulation as a surgical treatment for Parkinson’s disease. Neurology 55(Suppl 6):S60–S66

    CAS  PubMed  Google Scholar 

  12. Pollak P, Fraix V, Krack P, Moro E, Mendes A, Chabardes S, Koudsie A, Benabid A (2002) Treatment results: Parkinson’s disease. Mov Disord 17:S75–S83

    Article  PubMed  Google Scholar 

  13. Pollak P, Krack P, Fraix V, Moro E, Mendes A, Chabardes S, Koudsie A, Benabid A (2002) Intraoperative micro- and macrostimulation of the subthalamic nucleus in Parkinson’s disease. Mov Disord 17(Suppl 3):S155–S161

    Article  PubMed  Google Scholar 

  14. Rodriguez-Oroz MC, Gorospe A, Guridi J, Ramos E, Linazasoro G, Rodriguez-Palmero M, Obeso J (2002) Bilateral deep brain stimulation of the subthalamic nucleus in Parkinson’s disease. Neurology 55(Suppl 6):S45–S51

    Google Scholar 

  15. Schaltenbrand G, Wahren W (1997) Atlas for stereotaxy of the human brain. Georg Thieme, New York

    Google Scholar 

  16. Sutcliffe A, Mitchell R, Mocroft P (2004) General anaesthesia for placement of electrodes in the subthalamic nucleus to treat Parkinson’s disease does not worsen outcome. Eur J Anaesthesiol 21(Suppl 32):100

    Article  Google Scholar 

Download references

Acknowledgements

The authors are extremely grateful to all members of the Parkinson’s disease team, especially those who have not been mentioned by name. Team work and attention to detail are essential. All members of the team have key roles and we value their immense contribution to the successful outcome of Parkinson’s disease surgery.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Anaesthesia, Queen Elizabeth Neuroscience Centre, University Hospital Birmingham NHS Foundation Trust, B15 2TH, Birmingham, UK

    A. J. Sutcliffe

  2. Department of Neurosurgery, Queen Elizabeth Neuroscience Centre, University Hospital Birmingham NHS Foundation Trust, B15 2TH, Birmingham, UK

    R. D. Mitchell & Y. C. Gan

  3. Department of Electrophysiology, Queen Elizabeth Neuroscience Centre, University Hospital Birmingham NHS Foundation Trust, B15 2TH, Birmingham, UK

    A. P. Mocroft

  4. University Hospital Birmingham NHS Foundation Trust, B15 2TH, Birmingham, UK

    P. Nightingale

Authors
  1. A. J. Sutcliffe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. D. Mitchell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Y. C. Gan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. P. Mocroft
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Nightingale
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. D. Mitchell.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sutcliffe, A.J., Mitchell, R.D., Gan, Y.C. et al. General anaesthesia for deep brain stimulator electrode insertion in Parkinson’s disease. Acta Neurochir 153, 621–627 (2011). https://doi.org/10.1007/s00701-010-0845-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-010-0845-9

Keywords

Search

Navigation