Anesthetic Management of Parkinson's Patients Undergoing Deep Brain Stimulation

Surgical treatment for Parkinson’s disease has evolved from permanent removal of parts of the brain to minimally invasive surgical techniques such as deep brain stimulation. Ample evidence supports the efficacy and safety of DBS giving rise to its use in other clinical settings such as benign tremors, dystonia, epilepsy and other neuropsychiatric disorders. Anesthetic and surgical techniques for DBS may vary among institutions and physicians. Indirect surgical technique such as framebased imaging, is used to target brain structures even though frameless stereotactic techniques (direct technique) involving magnetic resonance imaging (MRI) have been described. Local, general anesthesia, and combined anesthetic techniques have been used. Although local anesthesia seems to offer better intraoperative evaluation of the neurological responses, it may be associated with intraoperative complications such as anxiety, hypertension and hemorrhage. General anesthesia is a common practice for the insertion of generator and tunneling of leads. No standardized guidelines for anesthesia management of Parkinson’s patient undergoing DBS have been described and clinical findings regarding ideal anesthetic technique are controversial.