J Korean Med Sci. 2014 Sep;29(9):1278-86. doi: 10.3346/jkms.2014.29.9.1278. Epub 2014 Sep 2.

Influence of propofol and fentanyl on deep brain stimulation of the subthalamic nucleus.

Kim W¹, Song IH², Lim YH¹, Kim MR¹, Kim YE³, Hwang JH¹, Kim IK¹, Song SW¹, Kim JW¹, Lee WW³, Kim HJ³, Kim C⁴, Kim HC⁵, Kim IY⁶, Park HP⁷, Kim DG¹, Jeon BS⁸, Paek SH⁹.

Author information

1: Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
2: Medical Device Development Center, Osong Medical Innovation Foundation, Cheongwon, Korea.
3: Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.
4: Medical Imaging Laboratory and CyberMed, Inc., Seoul, Korea.
5: Department of Medical Engineering, Seoul National University College of Medicine, Seoul, Korea.
6: Department of Biomedical Engineering, Hanyang University, Seoul, Korea.
7: Department of Anaesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea.
8: Department of Neurology, Seoul National University College of Medicine, Seoul, Korea. ; Ischemic/Hypoxic Disease Institute, Seoul National University College of Medicine, Seoul, Korea.
9: Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea. ; Ischemic/Hypoxic Disease Institute, Seoul National University College of Medicine, Seoul, Korea. ; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. ; Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.

Abstract

We investigated the effect of propofol and fentanyl on microelectrode recording (MER) and its clinical applicability during subthalamic nucleus (STN) deep brain stimulation (DBS) surgery. We analyzed 8 patients with Parkinson's disease, underwent bilateral STN DBS with MER. Their left sides were done under awake and then their right sides were done with a continuous infusion of propofol and fentanyl under local anesthesia. The electrode position was evaluated by preoperative MRI and postoperative CT. The clinical outcomes were assessed at six months after surgery. We isolated single unit activities from the left and the right side MERs. There was no significant difference in the mean firing rate between the left side MERs (38.7 ± 16.8 spikes/sec, n=78) and the right side MERs (35.5 ± 17.2 spikes/sec, n=66). The bursting pattern of spikes was more frequently observed in the right STN than in the left STN. All the electrode positions were within the STNs on both sides and the off-time Unified Parkinson's Disease Rating Scale part III scores at six months after surgery decreased by 67% of the preoperative level. In this study, a continuous infusion of propofol and fentanyl did not significantly interfere with the MER signals from the STN. The results of this study suggest that propofol and fentanyl can be used for STN DBS in patients with advanced Parkinson's disease improving the overall experience of the patients.