在帕金森病的深度大脑刺激手术中醒着与睡眠麻醉:系统性审查和元分析
Michelle L Lim1,2, Angela B B Zhan3, Sherry J Liu4
1Department of Surgical Intensive Care, Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, Singapore.
Stereotactic and functional neurosurgery
|April 18, 2024
概括
对于帕金森病 (PD) 的清醒或睡眠深度大脑刺激 (DBS) 显示了类似的临床结果. 患者的舒适性和手术团队的经验是成功进行DBS手术的关键因素.
科学领域:
- 神经外科 神经外科
- 神经学 神经学
- 麻醉学 麻醉学
背景情况:
- 深度大脑刺激 (DBS) 是对帕金森病 (PD) 的标准手术治疗方法.
- 传统上,PD的DBS需要患者在局部麻醉下保持清醒,以便进行手术内神经生理学监测.
- 总麻醉可以提高患者的舒适度,而不会影响解剖学准确性或临床结果.
研究的目的:
- 系统地审查和比较醒着与睡眠DBS手术对帕金森病的结果.
- 分析两种麻醉技术之间的临床有效性,手术并发症和患者报告的结果.
主要方法:
- 一项系统性审查和对19项涉及1,900名接受PDDBS治疗的患者的研究的元分析.
- 包括的研究比较了通过随机对照试验,前性和回顾性设计的清醒和睡眠DBS技术.
主要成果:
- 在临床有效性 (UPDRS III,利沃多巴剂量,刺激参数) 或患者报告的结果 (生活质量,情绪,认知) 中,在清醒和睡眠的DBS之间没有发现显著差异.
- 手术时间在两组之间显示出显著的异质性,但其他手术和麻醉相关的并发症是可比的.
结论:
- 技术的进步正在减少清醒和睡眠DBS程序之间的结果差异.
- 患者的舒适性,临床状态和手术团队的熟悉性对于优化DBS程序和患者护理至关重要.
相关概念视频
Stages of General Anesthesia
426
Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
426
General Anesthesia: Overview
215
Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
215
Parkinson's Disease: Treatment
264
Neurodegenerative disorders, such as Parkinson's Disease (PD), involve the gradual and irreversible destruction of neurons in particular brain areas. These disorders exhibit standard features like proteinopathies, selective vulnerability of some neurons, and an interaction of intrinsic properties, genetics, and environmental influences in neural injury.
Parkinson's Disease is primarily a result of the loss of dopaminergic neurons in the substantia nigra pars compacta. The cornerstone of...
Parkinson's Disease is primarily a result of the loss of dopaminergic neurons in the substantia nigra pars compacta. The cornerstone of...
264
Subconsciousness and No Awareness
241
The concept of subconscious awareness refers to the processing of information below the level of conscious thought, which significantly influences both behaviors and decisions. It is also known as waking subconscious awareness. This complex level of cognition operates without the direct awareness of the individual, facilitating rapid and simultaneous handling of multiple information streams.
An illustrative example of subconscious processing is its role in problem-solving. Often, individuals...
An illustrative example of subconscious processing is its role in problem-solving. Often, individuals...
241
Parkinson's Disease: Overview
541
Neurodegenerative disorders are progressive diseases that cause irreversible damage and loss to neurons in specific brain areas. Examples of these disorders include Parkinson's disease, Alzheimer's disease, Multiple Sclerosis (MS), and Amyotrophic Lateral Sclerosis (ALS). These disorders share characteristics such as proteinopathies, selective neuronal vulnerability, and a complex interplay between genetic and environmental factors. The primary therapeutic goal for these conditions is...
541


