Clinical Experience with Dexmedetomidine for Implantation of Deep Brain Stimulators in Parkinson's Disease

In Brief The pharmacologic profile of the α-2 agonist dexmedetomidine (Dex) suggests that it may be an ideal sedative drug for deep brain stimulator (DBS) implantation. We performed a retrospective chart review of anesthesia records of patients who underwent DBS implantation from 2001 to 2004. In 2003, a clinical protocol with Dex sedation for DBS implantation was initiated. Demographic data, use of antihypertensive medication, and duration of mapping were compared between patients who received Dex (11 patients/13 procedures) and patients who did not receive any sedation (controls: 8 patients/9 procedures). There were no differences in severity of illness between the two groups. Dex provided patient comfort and surgical satisfaction with mapping in all cases, and significantly reduced the use of antihypertensive medication (54% in the Dex group, versus 100% in controls, P = 0.048). In DBS implantation, sedation with Dex did not interfere with electrophysiologic mapping, and provided hemodynamic stability and patient comfort. Routine use of Dex in these procedures may be indicated. IMPLICATIONS: Implantation of deep brain stimulators (DBS) is an accepted treatment for patients with advanced Parkinson's disease. The anesthetic management of these procedures is challenging because sedative and anesthetic drugs may interfere with electrophysiologic monitoring. Sedation with the α-2 agonist, dexmedetomidine, in DBS implantations may be advantageous, allowing for better blood pressure control without interfering with microelectrode recording.