Preservation of microelectrode recordings with non-GABAergic drugs during deep brain stimulator placement in children.
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.
['Hippard|Helena Karlberg|HK|', 'Watcha|Mehernoor|M|', 'Stocco|Amber J|AJ|', 'Curry|Daniel|D|']
D000293:Adolescent D000758:Anesthesia D019162:Anesthetics, Combined D000778:Anesthetics, Dissociative D000959:Antihypertensive Agents D002648:Child D046690:Deep Brain Stimulation D020927:Dexmedetomidine D004421:Dystonia D020821:Dystonic Disorders D005260:Female D006801:Humans D006993:Hypnotics and Sedatives D007649:Ketamine D008297:Male D008839:Microelectrodes D064926:Neurophysiological Monitoring D009529:Nicardipine D010880:Piperidines D000077208:Remifentanil D012890:Sleep D014851:Wakefulness
microelectrode recording deep brain stimulation sedative DBS = deep brain stimulation GABA = γ-aminobutyric acid GPi = globus pallidus internus LMA = laryngeal mask anesthesia MER = microelectrode recording anesthesia functional neurosurgery