Interleaved Propofol-Ketamine Maintains DBS Physiology and Hemodynamic Stability: A Double-Blind Randomized Controlled Trial.

For deep brain stimulation (DBS) surgery, an anesthesia regimen combining low-dose ketamine infusion with propofol sedation provided high-quality microelectrode recordings comparable to the standard awake approach. In a randomized trial of 30 Parkinson's patients undergoing subthalamic DBS, those receiving 0.25 mg/kg/h ketamine during physiological testing had similar electrophysiological signatures and lead localization as those receiving saline. Tremor amplitude was slightly lower under ketamine. Patients in the ketamine group reported significantly higher satisfaction with anesthesia. Motor improvement, measured by the Unified Parkinson's Disease Rating Scale part III, was similar between groups. No negative effects on hemodynamic stability or cognition were observed. Ketamine-induced conscious sedation appears to offer superior patient satisfaction and hemodynamic stability while maintaining comparable surgical outcomes.

Study at a glance

Abstract

The gold standard anesthesia for deep brain stimulation (DBS) surgery is the "awake" approach, using local anesthesia alone. Although it offers high-quality microelectrode recordings and therapeutic-window assessment, it potentially causes patients extreme stress and might result in suboptimal surgical outcomes. General anesthesia or deep sedation is an alternative, but may reduce physiological testing reliability and lead localization accuracy. The aim is to investigate a novel anesthesia regimen of ketamine-induced conscious sedation for the physiological testing phase of DBS surgery. Parkinson's patients undergoing subthalamic DBS surgery were randomly divided into experimental and control groups. During physiological testing, the groups received 0.25 mg/kg/h ketamine infusion and normal saline, respectively. Both groups had moderate propofol sedation before and after physiological testing. The primary outcome was recording quality. Secondary outcomes included hemodynamic stability, lead accuracy, motor and cognitive outcome, patient satisfaction, and adverse events. Thirty patients, 15 from each group, were included. Intraoperatively, the electrophysiological signature and lead localization were similar under ketamine and saline. Tremor amplitude was slightly lower under ketamine. Postoperatively, patients in the ketamine group reported significantly higher satisfaction with anesthesia. The improvement in Unified Parkinson's disease rating scale part-III was similar between the groups. No negative effects of ketamine on hemodynamic stability or cognition were reported perioperatively. Ketamine-induced conscious sedation provided high quality microelectrode recordings comparable with awake conditions. Additionally, it seems to allow superior patient satisfaction and hemodynamic stability, while maintaining similar post-operative outcomes. Therefore, it holds promise as a novel alternative anesthetic regimen for DBS. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.