Deep brain stimulation lead placement

Deep brain stimulation lead placement

Anesthesia type	General or awake
Airway	ETT or natural airway if awake
Lines and access	1-2 PIV
Monitors	Standard, 5-lead EKG
Primary anesthetic considerations
Preoperative
Intraoperative	If under MRI guidance, will need MRI-safe equipment. Keep very still for MRI images
Postoperative
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Subthalamic nucleus deep brain stimulation (DBS) lead placement is a neurosurgical procedure whereby leads for DBS are placed in the subthalamic nucleus to help control the tremors of Parkinson disease.

Overview

Indications

Parkinson disease

Preoperative management

Patient evaluation

System	Considerations
Airway
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Intraoperative management

Monitoring and access

• Standard ASA monitors
• 1-2 IVs

Induction and airway management

Induce general anesthesia with ETT if MRI guidance will be used.

If awake, patient should be kept calm and told to hold as still as possible. Consider dexmedetomidine bolus

Positioning

Supine, typically head 90 or 180 deg away

Maintenance and surgical considerations

If lead placement is guided by MRI, must use MRI-compatible monitors and machine. Consider hefty doses of NDMBs to maintain maximum stillness for better image quality.

If awake, consider dexmedetomidine infusion to assist. Goal is to keep patient still but not disinhibited.

Procedure variants

	Variant 1	Variant 2
Unique considerations
Indications
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications