Dexmedetomidine and arousal affect subthalamic neurons.
Identifieur interne : 002121 ( Ncbi/Curation ); précédent : 002120; suivant : 002122Dexmedetomidine and arousal affect subthalamic neurons.
Auteurs : William Jeffrey Elias [États-Unis] ; Marcel E. Durieux ; Diane Huss ; Robert C. FrysingerSource :
- Movement disorders : official journal of the Movement Disorder Society [ 1531-8257 ] ; 2008.
English descriptors
- KwdEn :
- Action Potentials (drug effects), Analgesics, Non-Narcotic (pharmacology), Arousal (physiology), Deep Brain Stimulation (methods), Dexmedetomidine (pharmacology), Humans, Microelectrodes, Neurons (drug effects), Parkinsonian Disorders (therapy), Retrospective Studies, Subthalamic Nucleus (cytology), Subthalamic Nucleus (drug effects).
- MESH :
- chemical , pharmacology : Analgesics, Non-Narcotic, Dexmedetomidine.
- cytology : Subthalamic Nucleus.
- drug effects : Action Potentials, Neurons, Subthalamic Nucleus.
- methods : Deep Brain Stimulation.
- physiology : Arousal.
- therapy : Parkinsonian Disorders.
- Humans, Microelectrodes, Retrospective Studies.
Abstract
Stereotactic neurosurgeons hesitate to employ sedation in cases requiring microelectrode recording (MER). We report our experience with dexmedetomidine during MER of subthalamic nucleus (STN). Eleven Parkinsonian patients received dexmedetomidine during deep brain stimulation surgery. Seven received continuous IV infusions during MER in the STN. The bispectral index (BIS) was used to estimate the level of consciousness. The quality of MER was evaluated as a function of BIS, clinical arousal, and dexmedetomidine dose. MER during wakefulness (BIS > 80; 0.1 to 0.4 mcg/kg/hr dexmedetomidine) was similar to the unmedicated state. Subthalamic MER was reduced when the patient was asleep or unarousable (BIS < 80). Anxiolysis persisted for hours. Arousal affects STN neurons. Dexmedetomidine "cooperative sedation," from which the patient is easily aroused, provides interpretable STN MER and prolonged anxiolysis. We suggest dexmedetomidine infusions without a loading dose, a relatively low infusion rate, and discontinuation after completion of the bur holes.
DOI: 10.1002/mds.22080
PubMed: 18442130
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pubmed:18442130Le document en format XML
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<author><name sortKey="Elias, William Jeffrey" sort="Elias, William Jeffrey" uniqKey="Elias W" first="William Jeffrey" last="Elias">William Jeffrey Elias</name>
<affiliation wicri:level="1"><nlm:affiliation>Department of Neurosurgery, University of Virginia, Charlottesville, Virginia 22908, USA. wje4r@virginia.edu</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Department of Neurosurgery, University of Virginia, Charlottesville, Virginia 22908</wicri:regionArea>
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<author><name sortKey="Durieux, Marcel E" sort="Durieux, Marcel E" uniqKey="Durieux M" first="Marcel E" last="Durieux">Marcel E. Durieux</name>
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<author><name sortKey="Huss, Diane" sort="Huss, Diane" uniqKey="Huss D" first="Diane" last="Huss">Diane Huss</name>
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<affiliation wicri:level="1"><nlm:affiliation>Department of Neurosurgery, University of Virginia, Charlottesville, Virginia 22908, USA. wje4r@virginia.edu</nlm:affiliation>
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<series><title level="j">Movement disorders : official journal of the Movement Disorder Society</title>
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<term>Arousal (physiology)</term>
<term>Deep Brain Stimulation (methods)</term>
<term>Dexmedetomidine (pharmacology)</term>
<term>Humans</term>
<term>Microelectrodes</term>
<term>Neurons (drug effects)</term>
<term>Parkinsonian Disorders (therapy)</term>
<term>Retrospective Studies</term>
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<term>Subthalamic Nucleus (drug effects)</term>
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<term>Dexmedetomidine</term>
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<front><div type="abstract" xml:lang="en">Stereotactic neurosurgeons hesitate to employ sedation in cases requiring microelectrode recording (MER). We report our experience with dexmedetomidine during MER of subthalamic nucleus (STN). Eleven Parkinsonian patients received dexmedetomidine during deep brain stimulation surgery. Seven received continuous IV infusions during MER in the STN. The bispectral index (BIS) was used to estimate the level of consciousness. The quality of MER was evaluated as a function of BIS, clinical arousal, and dexmedetomidine dose. MER during wakefulness (BIS > 80; 0.1 to 0.4 mcg/kg/hr dexmedetomidine) was similar to the unmedicated state. Subthalamic MER was reduced when the patient was asleep or unarousable (BIS < 80). Anxiolysis persisted for hours. Arousal affects STN neurons. Dexmedetomidine "cooperative sedation," from which the patient is easily aroused, provides interpretable STN MER and prolonged anxiolysis. We suggest dexmedetomidine infusions without a loading dose, a relatively low infusion rate, and discontinuation after completion of the bur holes.</div>
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