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63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

13. - 16. Juni 2012, Leipzig

Anesthesiologic regimen and intraoperative confusion in PD-DBS surgery

Meeting Abstract

  • M. Lange - Klinik und Poliklinik für Neuchirurgie, Universitätsklinikum Regensburg
  • E. Hansen - Klinik für Anästhesiologie, Universitätsklinikum Regensburg
  • A. Janzen - Klinik und Poliklinik für Neurologie, Universitätsklinikum Regensburg
  • N. Weitl - Klinik für Anästhesiologie, Universitätsklinikum Regensburg
  • A. Brawanski - Klinik und Poliklinik für Neuchirurgie, Universitätsklinikum Regensburg
  • J. Schlaier - Klinik und Poliklinik für Neuchirurgie, Universitätsklinikum Regensburg

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP 045

DOI: 10.3205/12dgnc432, URN: urn:nbn:de:0183-12dgnc4322

Veröffentlicht: 4. Juni 2012

© 2012 Lange et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: To investigate the influence of anesthetics on intraoperative orientation. Standard anesthesiological care for STN-DBS-surgery in PD patients is a sleep-awake procedure. But some patients become confused during the operation and anesthetics can compromise ventilation and hemodynamic stability. In addition, these drugs interfere with the patient’s alertness and cooperativeness, the quality of microelectrode recordings and the recognition of undesired stimulation effects. We report a new method that avoids centrally acting drugs and instead relies on scalp blocks, continuous care and therapeutic communication.

Methods: 53 consecutive patients (15 female, 38 male), mean age 64, were included in this retrospective study. Nonverbal support for the patient is maintained by hand-in-hand and hand-on-shoulder contact by the anaesthesiologist (E. H.). Negative suggestions are carefully avoided, positive suggestions given, and the patient's own resources utilized. The patient is offered dissociation to a “safe place”, “reframing” of disturbing sensations and noises, relaxing music, breathing and metaphors. The last 16 patients undergoing the standard procedure (group I) were compared to the first 16 (group II: “learning phase”) and the following 21 (group III: “routine phase”) patients treated with the new procedure.

Results: Confusion occurred in 3 patients in group I, in 1 patient in group II and in 0 patients in group III, p-value for comparison of group I and III was 0.038. The average duration of surgery declined from 316 to 236 and 243 min from group I to III. Scalp blocks provided better control of intraoperative and postoperative cranial pain than local anesthesia. The average amount of disoprivane was reduced from 156 (group I) to 16 (group II) to 0 (group III) mg, remifentanyl from 0.68 (group I) to 0.23 (group II) and 0.04 (group III) mg. While analgesics and hypnotics were always available on standby, with our new procedure 12 of 21 patients (57%) in group III did not require any anesthetics. Disorientation, agitation, hemodynamic instability, or hypoxic episodes were less frequent in groups II and III.

Conclusions: This study indicates that intraoperative confusion and reduced cooperation correlate with the amount of anesthetics used and that anesthetics can be significantly reduced in an appropriate setting. Prospective randomized clinical trials are necessary to show whether fully awake patients with unimpaired intraoperative testing also improves neurological outcome after DBS.