Ketamine Sedation Facilitates Asleep DBS: a multicenter retrospective study
medRxiv Preprint Server – December 12, 2021
Source: medRxiv
Summary
Brain surgery for Parkinson's often requires patients to be awake for precise mapping. A new analysis investigated if low-dose ketamine could allow sedation without compromising critical brain monitoring. This multi-center review found ketamine successfully facilitated "asleep" Deep Brain Stimulation, enabling accurate lead placement while significantly improving patient comfort. This offers a promising option for Parkinson's patients.
Abstract
Deep brain stimulation (DBS) is commonly and safely performed for selective Parkinson’s disease patients. Many centers perform DBS lead positioning exclusively under local anesthesia, to allow for brain microelectrode recordings (MER) and testing of stimulation-related therapeutic and side effects. These measures enable physiological identification of the DBS targets based on electrophysiological properties like firing rates and patterns, optimization of lead placement accuracy, and intra-operative evaluation of therapeutic window. Nevertheless, due to the challenges of awake surgery, some centers use sedation or general anesthesia, despite the distortion of discharge properties, and potential impact on clinical outcomes. Thus, there is a need for a novel anesthesia regimen that enables sedation without compromising intra-operative monitoring. This study investigates the use of low-dose ketamine for conscious sedation during lead positioning in subthalamic nucleus (STN) DBS for Parkinson’s disease patients.