Anesthesia for deep brain stimulation

Movement disorders such as Parkinson's disease, essential tremor and dystonia can be refractory to medical treatment resulting in a poor quality of life. Deep brain stimulation is a functional neurosurgical procedure effective in significantly improving the symptoms. It involves insertion of an electrode close to the deep brain target site and stimulating it through a battery operated pulse generator implanted in the chest wall. The insertion of the electrode is generally done with the patient awake and the head attached to a stereotactic frame in a MRI suite. The anesthetic management is challenging in view of the remote location, airway management, monitoring of neurocognitive function, ensuring patient comfort, maintaining stable cardiopulmonary status and prompt recognition of serious complications like acute airway obstruction, intracranial hemorrhage and venous air embolism. A comprehensive preoperative assessment, patient reassurance, meticulous planning and effective communication with the surgeon can result in a good patient outcome.