Newly Published
Perioperative Medicine  |   February 2020
Sevoflurane and Parkinson’s Disease: Subthalamic Nucleus Neuronal Activity and Clinical Outcome of Deep Brain Stimulation
Author Notes
  • From the Department of Neurosurgery (S.-T.T., S.-Y.C.) and Department of Anesthesiology (T.-Y.C.), Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation/Tzu Chi University, Hualien, Taiwan; and the Institute of Medical Sciences (S.-T.T., S.-Y.C.), and the Department of Anatomy (G.-F.T.) and Department of Physiology and Master Program in Medical Physiology (C.-C.K.), School of Medicine, Tzu Chi University, Hualien, Taiwan.
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • The work presented in this article has been presented at the American Association of Neurological Surgeons annual scientific meeting in Los Angeles, California, April 26, 2017.
    The work presented in this article has been presented at the American Association of Neurological Surgeons annual scientific meeting in Los Angeles, California, April 26, 2017.×
  • Submitted for publication May 29, 2019. Accepted for publication January 6, 2020.
    Submitted for publication May 29, 2019. Accepted for publication January 6, 2020.×
  • Correspondence: Address correspondence to Dr. Chen: Mail: 707, Sec. 3, Chung-Yang Road, Hualien, Taiwan, 970. william.sychen@msa.hinet.net. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Central and Peripheral Nervous Systems / Neurosurgical Anesthesia / Pharmacology
Perioperative Medicine   |   February 2020
Sevoflurane and Parkinson’s Disease: Subthalamic Nucleus Neuronal Activity and Clinical Outcome of Deep Brain Stimulation
Anesthesiology Newly Published on February 6, 2020. doi:https://doi.org/10.1097/ALN.0000000000003177
Anesthesiology Newly Published on February 6, 2020. doi:https://doi.org/10.1097/ALN.0000000000003177
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Accurate stimulating electrode placement is essential for clinically effective subthalamic nucleus brain stimulation in patients with Parkinson’s disease

  • General anesthetics-induced changes of electrical oscillations in the basal ganglia may render the identification of the stimulation targets difficult

  • The effects of sevoflurane-based general anesthesia on the electrophysiologic properties of subthalamic neurons, electrode placement efficacy, and long-term clinical outcomes in Parkinson’s disease have not been previously reported

What This Article Tells Us That Is New:

  • When compared to local anesthesia, sevoflurane-based general anesthesia decreased beta-frequency oscillations and induced coherent lower frequency oscillations in the subthalamic nucleus of patients with Parkinson’s disease undergoing electrode placement for deep brain stimulation

  • These sevoflurane-induced changes in electrical activity patterns did not reduce electrode placement accuracy or clinical outcome

  • These observations suggest that electrode placement for deep brain stimulation under sevoflurane anesthesia is a feasible clinical option

Background: General anesthetics-induced changes of electrical oscillations in the basal ganglia may render the identification of the stimulation targets difficult. The authors hypothesized that while sevoflurane anesthesia entrains coherent lower frequency oscillations, it does not affect the identification of the subthalamic nucleus and clinical outcome.

Methods: A cohort of 19 patients with Parkinson’s disease with comparable disability underwent placement of electrodes under either sevoflurane general anesthesia (n = 10) or local anesthesia (n = 9). Microelectrode recordings during targeting were compared for neuronal spiking characteristics and oscillatory dynamics. Clinical outcomes were compared at 5-yr follow-up.

Results: Under sevoflurane anesthesia, subbeta frequency oscillations predominated (general vs. local anesthesia, mean ± SD; delta: 13 ± 7.3% vs. 7.8 ± 4.8%; theta: 8.4 ± 4.1% vs. 3.9 ± 1.6%; alpha: 8.1 ± 4.1% vs. 4.8 ± 1.5%; all P < 0.001). In addition, distinct dorsolateral beta and ventromedial gamma oscillations were detected in the subthalamic nucleus solely in awake surgery (mean ± SD; dorsal vs. ventral beta band power: 20.5 ± 6.6% vs. 15.4 ± 4.3%; P < 0.001). Firing properties of subthalamic neurons did not show significant difference between groups. Clinical outcomes with regard to improvement in motor and psychiatric symptoms and adverse effects were comparable for both groups. Tract numbers of microelectrode recording, active contact coordinates, and stimulation parameters were also equivalent.

Conclusions: Sevoflurane general anesthesia decreased beta-frequency oscillations by inducing coherent lower frequency oscillations, comparable to the pattern seen in the scalp electroencephalogram. Nevertheless, sevoflurane-induced changes in electrical activity patterns did not reduce electrode placement accuracy and clinical effect. These observations suggest that microelectrode-guided deep brain stimulation under sevoflurane anesthesia is a feasible clinical option.