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

Surgical procedure

Preoperative management

Patient evaluation

System Considerations
Airway
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

Operating room setup

Patient preparation and premedication

Regional and neuraxial techniques

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.

Emergence

Postoperative management

Disposition

Pain management

Potential complications

Procedure variants

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

References