Remifentanil stabilizes hemodynamics with modulating subthalamic beta oscillation during deep brain stimulation.

Area of Science:

• Neurosurgery
• Anesthesiology
• Neuroscience

Background:

• Deep brain stimulation (DBS) is an option for advanced Parkinson's disease (PD) patients.
• General anesthesia for DBS requires low anesthetic levels to maintain recording quality, risking hemodynamic instability.
• Remifentanil may mitigate these risks due to its sedative and analgesic effects.

Purpose of the Study:

• To evaluate the effect of remifentanil co-administration on subthalamic nucleus (STN) neuronal activity and hemodynamic stability during general anesthesia for PD DBS surgery.
• To compare microelectrode recording characteristics and hemodynamic responses between patients receiving volatile anesthesia with and without remifentanil.

Main Methods:

• Retrospective analysis of 24 Parkinson's disease patients undergoing STN-DBS surgery.
• Patients received controlled volatile anesthesia with (n=12) or without (n=12) remifentanil infusion.
• Comprehensive spike analysis (frequency, interval, burst/pause indices) and spike frequency spectrum analysis were performed.

Main Results:

• No significant differences in STN neuronal firing characteristics were found between groups.
• A significant reduction in high beta power in multi-unit activity was observed in the remifentanil group.
• Nine patients in the non-remifentanil group required nicardipine for hemodynamic management, compared to none in the remifentanil group.

Conclusions:

• Remifentanil co-administration during general anesthesia for STN-DBS in Parkinson's disease patients did not affect STN firing characteristics.
• Remifentanil effectively reduced high beta power and improved hemodynamic stability, decreasing the need for antihypertensive medication.
• Remifentanil is a viable option for managing hemodynamic instability in PD patients undergoing DBS surgery under general anesthesia.