الفهرس 
Indications of Deep Brain StimulationOnly 14 pages are availabe for public view
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Abstract
Deep brain stimulation (DBS) is a surgical treatment involving the implantation of a medical device called a brain pacemaker, which sends electrical impulses to specific parts of the brain. DBS in selected brain regions has provided remarkable therapeutic benefits for treating resistant movement disorders and others such as chronic pain, cluster headache and epilepsy.
Also the field of psychiatry shows a great interest in DBS because there is a little risk of complications and because it is reversible and postoperatively adjustable to optimize the treatment. DBS is being investigated as a potential treatment for obsessive compulsive disorder (OCD) and major depressive disorder. DBS will be the treatment of choice for chronic-refractory psychiatric disorders.
The insertion of the deep brain stimulator (DBS) is a minimally invasive procedure that includes the placement of electrodes into deep brain structures for microelectrode recordings (MERs) and macrostimulation for clinically testing the patient and connection of the DBS to an implanted pacemaker.
The anesthesiologist plays a key role in the management of patients for the insertion of a DBS. The anesthetic technique varies depending on the traditions and requirements of each institution performing these procedures and has included monitored anesthesia care under local anesthesia, conscious sedation, (awake asleep awake) technique and general anesthesia.
Successful treatment with a DBS depends on proper patient selection. A multidisciplinary team consisting of neurologists, neurosurgeons, neurophysiologists, neuropsychologists, and psychiatrists initially evaluates the patient. Selection of an ideal patient includes an overall assessment of the patient with respect to diagnosis, cognitive and psychiatric status, access to care, and expectations by the patient, and the patient’s response to medical treatment.
The insertion of a DBS is not without the potential for perioperative complications, which demands vigilance in rapid recognition and treatment of these events by the anesthesiologist.
Overall, intraprocedure complications have been reported to occur in 12% to 16% of patients. Intraoperative respiratory complications are of great concern, occurring in 1.6% to 2.2% of patients.
In the awake patient, they may result from oversedation or intracranial events such as seizures or hemorrhage leading to a decreased level of consciousness. Acute airway obstruction may occur in a restless awake patient as the body shifts but the head remains fixed to the bed.
With the increasing use of DBS, there is an ever greater chance of the anesthetist encountering such a patient outside of the neurosurgical environment. These patients may present for routine anesthesia under a different surgical specialty or may present to other specialties as emergency admissions requiring an input into their care. Anesthesia in patients with an implanted neurostimulator requires special considerations because of possible interference between the neurostimulators and the other devices.