gms | German Medical Science

Objective: To investigate the influence of anesthesia on intraoperative patient anxiety and cooperation. 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. Furthermore reports show that individual patients suffer from severe loneliness and helplessness during surgery. We present a new method that avoids narcotics and instead relies on scalp blocks, continuous care and therapeutic communication.

Method: A questionnaire was sent to all patients retrospectively and data on patient satisfaction and distress during surgery was analysed. Data-sets from 50 patients (29% female), mean age 62,5 could be evaluated. During surgery nonverbal support for the patient is maintained by hand-in-hand and hand-on-shoulder contact by the anaesthesiologist. The patient is offered dissociation to a “safe place”, “reframing” of disturbing sensations and noises, relaxing music, breathing and metaphors. The last 8 patients undergoing the standard procedure (group I) were compared to the first 9 (group II: “learning phase”) and the following 32 (group III: “routine phase”) patients treated with the new procedure.

Results: Confusion was significantly (p=0,03) more frequent in the narcotics-group (I) compared to the no-narcotics-group (III). The average amount of disoprivane was reduced from 156 (group I) to 16 (group II) and 0 (group III) mg (p-value I -> III: <0.001), remifentanyl from 0.68 (group I) to 0.23 (group II) and 0.04 (group III) mg (p-value I -> III: <0.001). The average duration of surgery declined from 316 to 243 min from group I to III. The feeling of being left alone lost during surgery decreased significantly from 75,0% of patients in group I to 16,13% in group III (p=0,007).

Conclusions: This study indicates that patient satisfaction and cooperation improves significantly with verbal and nonverbal support and the reduction of anesthetics in a complete awake surgical setting. Prospective randomized clinical trials are necessary to show whether fully awake patients with unimpaired intraoperative testing also have better functional outcome after DBS.