Is the Subthalamic Nucleus Sleeping Under Nitrous Oxide-Ketamine General Anesthesia?
Halen Baker Erdman1, Hagai Bergman1,2,3, Karin Abu Haya2
1Department of Medical Neurobiology, Hebrew University of Jerusalem, Ein Kerem Campus, Jerusalem, Israel.
The European Journal of Neuroscience
|March 5, 2025
Summary
Nitrous oxide-ketamine anesthesia allows subthalamic nucleus identification during deep brain stimulation surgery, though it reduces beta frequency power and motor subregion delineation compared to awake or ketamine sedation.
Area of Science:
- Neurosurgery
- Anesthesiology
- Neurophysiology
Background:
- Deep brain stimulation (DBS) for movement disorders relies on precise microelectrode recordings.
- Anesthetic effects on brain electrophysiology during DBS are critical for surgical accuracy.
- Nitrous oxide is a common anesthetic with analgesic properties.
Purpose of the Study:
- To investigate the impact of nitrous oxide-ketamine general anesthesia on subthalamic nucleus (STN) electrophysiology during DBS.
- To compare STN electrophysiological characteristics under nitrous oxide-ketamine anesthesia versus awake or ketamine sedation.
- To assess the feasibility of STN identification and subregion delineation under different anesthetic conditions.
Main Methods:
- Retrospective analysis of electrophysiological data from three medical centers.
- Spectral analysis of STN electrical signals.
- Statistical analysis of STN electrophysiological dimensions and frequency power (delta and beta bands).
Main Results:
- Nitrous oxide-ketamine anesthesia enabled STN identification, with slightly decreased overall activity.
- Significantly lower beta frequency power was observed in the STN under nitrous oxide-ketamine compared to awake/ketamine groups.
- Delta frequency oscillations aided in STN subregion delineation; no differences in nucleus dimensions were found across groups.
- Delineation of the motor subregion was more challenging under nitrous oxide-ketamine anesthesia.
Conclusions:
- STN entrance and exit can be identified with high confidence under nitrous oxide-ketamine anesthesia.
- Nitrous oxide-ketamine anesthesia impacts STN electrophysiology, particularly reducing beta power.
- The motor subregion of the STN is less precisely delineated under nitrous oxide-ketamine compared to awake/ketamine conditions, potentially affecting surgical outcomes.
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