Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 3/2017

01-03-2017 | Review Article/Brief Review

Anesthesia considerations for patients with an implanted deep brain stimulator undergoing surgery: a review and update

Authors: Tze Yeng Yeoh, MBChB, Pirjo Manninen, MD, Suneil K. Kalia, MD, PhD, Lashmi Venkatraghavan, MD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 3/2017

Login to get access

Abstract

Purpose

Deep brain stimulation (DBS) can be an effective treatment option for patients with essential tremor and Parkinson’s disease. This review provides an overview on the functioning of neurostimulators and recent advances in this technology and presents an updated guide on the anesthetic management of patients with an implanted neurostimulator undergoing surgery or medical intervention.

Source

A search was conducted on MEDLINE®, EMBASE™, and Cochrane Database of Systematic Reviews databases to identify studies published in English from 1974 to December 2015. Our search also included relevant and available incident reports from the manufacturers, Health Canada, the United States Food and Drug Administration, and the European Medicines Agency. Thirty of 232 articles identified were found to be relevant to this review.

Principal findings

Deep brain stimulation systems now offer a range of options, including pulse generators with dual-channel capabilities, rechargeable batteries, and current-control modes. Preoperatively, the anesthesiologist should ascertain the indications for DBS therapy, identify the type of device implanted, and consult a DBS specialist for specific precautions and device management. The major perioperative concern is the potential for interactions with the medical device resulting in patient morbidity. Neurostimulators should be turned off intraoperatively to minimize electromagnetic interference, and precautions should be taken when using electrosurgical equipment. Following surgery, the device should be turned on and checked by a DBS specialist.

Conclusion

The anesthesiologist plays an important role to ensure a safe operating environment for patients with an implanted DBS device. Pertinent issues include identifying the type of device, involving a DBS-trained physician, turning off the device intraoperatively, implementing precautions when using electrosurgical equipment, and checking the device postoperatively.
Footnotes
1
The MRI guideline for the new St Jude Medical DBS system is not available as the device is currently not commercially available in Canada.
 
Literature
1.
Kalia SK, Sankar T, Lozano AM. Deep brain stimulation for Parkinson’s disease and other movement disorders. Curr Opin Neurol 2013; 26: 374-80.CrossRefPubMed
2.
American Society of Anesthesiologists. Practice advisory for the perioperative management of patients with cardiac implantable electronic devices: pacemakers and implantable cardioverter-defibrillators: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Cardiac Implantable Electronic Devices. Anesthesiology 2011; 114: 247-61.CrossRef
3.
Healey JS, Merchant R, Simpson C, et al. Canadian Cardiovascular Society/Canadian Anesthesiologists’ Society/Canadian Heart Rhythm Society joint position statement on the perioperative management of patients with implanted pacemakers, defibrillators, and neurostimulating devices. Can J Cardiol 2012; 28: 141-51.CrossRefPubMed
4.
Benabid AL, Pollak P, Louveau A, Henry S, de Rougemont J. Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson disease. Appl Neurophysiol 1987; 50: 344-6.PubMed
5.
Venkatraghavan L, Manninen P. Anesthesia for deep brain stimulation. Curr Opin Anaesthesiol 2011; 24: 495-9.CrossRefPubMed
6.
Lozano AM, Lipsman N. Probing and regulating dysfunctional circuits using deep brain stimulation. Neuron 2013; 77: 406-24.CrossRefPubMed
7.
Montgomery EB Jr, Gale JT. Mechanisms of action of deep brain stimulation (DBS). Neurosci Biobehav Rev 2008; 32: 388-407.CrossRefPubMed
8.
Miocinovic S, Lempka SF, Russo GS, et al. Experimental and theoretical characterization of the voltage distribution generated by deep brain stimulation. Exp Neurol 2009; 216: 166-76.CrossRefPubMed
9.
Lempka SF, Johnson MD, Miocinovic S, Vitek JL, McIntyre CC. Current-controlled deep brain stimulation reduces in vivo voltage fluctuations observed during voltage-controlled stimulation. Clin Neurophysiol 2010; 121: 2128-33.CrossRefPubMedPubMedCentral
10.
11.
12.
Korpas D. Basic principles of cardiac pacemaker technology. In: Korpas D, editor. Implantable Cardiac Devices Technology. New York: Springer Science + Business Media New York; 2013. p. 7-12.CrossRef
13.
Poon CC, Irwin MG. Anaesthesia for deep brain stimulation and in patients with implanted neurostimulator devices. Br J Anaesth 2009; 103: 152-65.CrossRefPubMed
14.
Venkatraghavan L, Luciano M, Manninen P. Review article: anesthetic management of patients undergoing deep brain stimulator insertion. Anesth Analg 2010; 110: 1138-45.PubMed
15.
Nutt JG, Anderson VC, Peacock JH, Hammerstad JP, Burchiel KJ. DBS and diathermy interaction induces severe CNS damage. Neurology 2001; 56: 1384-6.CrossRefPubMed
16.
Ruggera PS, Witters DM, von Maltzahn G, Bassen HI. In vitro assessment of tissue heating near metallic medical implants by exposure to pulsed radio frequency diathermy. Phys Med Biol 2003; 48: 2919-28.CrossRefPubMed
17.
Riordan AT, Gamache C, Fosko SW. Electrosurgery and cardiac devices. J Am Acad Dermatol 1997; 37: 250-5.CrossRefPubMed
18.
19.
Khetarpal M, Yadav M, Kulkarni D, Gopinath R. Anaesthetic management of a patient with deep brain stimulation implant for radical nephrectomy. Indian J Anaesth 2014; 58: 461-3.CrossRefPubMedPubMedCentral
20.
Weaver J, Kim SJ, Lee MH, Torres A. Cutaneous electrosurgery in a patient with a deep brain stimulator. Dermatol Surg 1999; 25: 415-7.CrossRefPubMed
21.
Martinelli PT, Schulze KE, Nelson BR. Mohs micrographic surgery in a patient with a deep brain stimulator: a review of the literature on implantable electrical devices. Dermatol Surg 2004; 30: 1021-30.PubMed
22.
Boston Scientific Corporation. Vercise™ Deep Brain Stimulation System Physician Manual. Marlborough: Boston Scientific Corporation; 2014.
23.
Minville V, Chassery C, Benhaoua A, Lubrano V, Albaladejo P, Fourcade O. Nerve stimulator-guided brachial plexus block in a patient with severe Parkinson’s disease and bilateral deep brain stimulators. Anesth Analg 2006; 102: 1296.CrossRefPubMed
24.
Gandhi R, Chawla R. Anaesthetic management of shoulder arthroscopic repair in Parkinson’s disease with deep brain stimulator. Indian J Anaesth 2014; 58: 309-11.CrossRefPubMedPubMedCentral
25.
Venkatraghavan L, Chinnapa V, Peng P, Brull R. Non-cardiac implantable electrical devices: brief review and implications for anesthesiologists. Can J Anesth 2009; 56: 320-6.CrossRefPubMed
26.
27.
Parsloe CF, Twomey JM. Safety of phacoemulsification in a patient with an implanted deep brain neurostimulation device. Br J Ophthalmol 2005; 89: 1370-1.CrossRefPubMedPubMedCentral
28.
Ozturk F, Osher RH. Phacoemulsification in a patient with a deep brain stimulator. J Cataract Refract Surg 2006; 32: 687-8.CrossRefPubMed
29.
30.
31.
Rosenow JM, Tarkin H, Zias E, Sorbera C, Mogilner A. Simultaneous use of bilateral subthalamic nucleus stimulators and an implantable cardiac defibrillator. Case report. J Neurosurg 2003; 99: 167-9.PubMed
32.
Garg R, Borthakur B, Pawar M. Management of patient with deep brain stimulator for emergency laparotomy. J Neurosurg Anesthesiol 2011; 23: 168.CrossRefPubMed
33.
Martin WA, Camenzind E, Burkhard PR. ECG artifact due to deep brain stimulation. Lancet 2003; 361: 1431.CrossRefPubMed
34.
Constantoyannis C, Heilbron B, Honey CR. Electrocardiogram artifacts caused by deep brain stimulation. Can J Neurol Sci 2004; 31: 343-6.CrossRefPubMed
35.
Frysinger RC, Quigg M, Elias WJ. Bipolar deep brain stimulation permits routine EKG, EEG, and polysomnography. Neurology 2006; 66: 268-70.CrossRefPubMed
36.
Senatus PB, McClelland S 3rd, Ferris AD, et al. Implantation of bilateral deep brain stimulators in patients with Parkinson disease and preexisting cardiac pacemakers. Report of two cases. J Neurosurg 2004; 101: 1073-7.PubMed
37.
Capelle HH, Simpson RK, Kronenbuerger M, Michaelsen J, Tronnier V, Krauss JK. Long-term deep brain stimulation in elderly patients with cardiac pacemakers. J Neurosurg 2005; 102: 53-9.CrossRefPubMed
38.
Ozben B, Bilge AK, Yilmaz E, Adalet K. Implantation of a permanent pacemaker in a patient with severe Parkinson’s disease and a preexisting bilateral deep brain stimulator. Int Heart J 2006; 47: 803-10.CrossRefPubMed
39.
Obwegeser AA, Uitti RJ, Turk MF, et al. Simultaneous thalamic deep brain stimulation and implantable cardioverter-defibrillator. Mayo Clin Proc 2001; 76: 87-9.CrossRefPubMed
40.
Tavernier R, Fonteyne W, Vandewalle V, de Sutter J, Gevaert S. Use of an implantable cardioverter defibrillator in a patient with two implanted neurostimulators for severe Parkinson’s disease. Pacing Clin Electrophysiol 2000; 23: 1057-9.CrossRefPubMed
41.
Voges J, Waerzeggers Y, Maarouf M, et al. Deep-brain stimulation: long-term analysis of complications caused by hardware and surgery–experiences from a single centre. J Neurol Neurosurg Psychiatry 2006; 77: 868-72.CrossRefPubMedPubMedCentral
42.
Sillay KA, Larson PS, Starr PA. Deep brain stimulator hardware-related infections: incidence and management in a large series. Neurosurgery 2008; 62: 360-6.CrossRefPubMed
43.
Bhatia R, Dalton A, Richards M, Hopkins C, Aziz T, Nandi D. The incidence of deep brain stimulator hardware infection: the effect of change in antibiotic prophylaxis regimen and review of the literature. Br J Neurosurg 2011; 25: 625-31.CrossRefPubMed
44.
Piacentino M, Pilleri M, Bartolomei L. Hardware-related infections after deep brain stimulation surgery: review of incidence, severity and management in 212 single-center procedures in the first year after implantation. Acta Neurochir (Wien) 2011; 153: 2337-41.CrossRef
45.
Pepper J, Zrinzo L, Mirza B, Foltynie T, Limousin P, Hariz M. The risk of hardware infection in deep brain stimulation surgery is greater at impulse generator replacement than at the primary procedure. Stereotact Funct Neurosurg 2013; 91: 56-65.CrossRefPubMed
46.
Bjerknes S, Skogseid IM, Sæhle T, Dietrichs E, Toft M. Surgical site infections after deep brain stimulation surgery: frequency, characteristics and management in a 10-year period. PLoS One 2014; 9: e105288.CrossRefPubMedPubMedCentral
47.
48.
49.
50.
Gleason CA, Kaula NF, Hricak H, Schmidt RA, Tanagho EA. The effect of magnetic resonance imagers on implanted neurostimulators. Pacing Clin Electrophysiol 1992; 15: 81-94.CrossRefPubMed
51.
Tronnier VM, Staubert A, Hähnel S, Sarem-Aslani A. Magnetic resonance imaging with implanted neurostimulators: an in vitro and in vivo study. Neurosurgery 1999; 44: 118-25.CrossRefPubMed
52.
Finelli DA, Rezai AR, Ruggieri PM, et al. MR imaging-related heating of deep brain stimulation electrodes: in vitro study. AJNR Am J Neuroradiol 2002; 23: 1795-802.PubMed
53.
Rezai AR, Finelli D, Nyenhuis JA, et al. Neurostimulation systems for deep brain stimulation: in vitro evaluation of magnetic resonance imaging-related heating at 1.5 tesla. J Magn Reson Imaging 2002; 15: 241-50.CrossRefPubMed
54.
Kahan J, Papadaki A, White M, et al. The safety of using body-transmit MRI in patients with implanted deep brain stimulation devices. PLoS One 2015; 10: e0129077.CrossRefPubMedPubMedCentral
55.
Rezai AR, Phillips M, Baker KB, et al. Neurostimulation system used for deep brain stimulation (DBS): MR safety issues and implications of failing to follow safety recommendations. Invest Radiol 2004; 39: 300-3.CrossRefPubMed
56.
Spiegel J, Fuss G, Backens M, et al. Transient dystonia following magnetic resonance imaging in a patient with deep brain stimulation electrodes for the treatment of Parkinson disease. Case report. J Neurosurg 2003; 99: 772-4.PubMed
57.
Henderson JM, Tkach J, Phillips M, Baker K, Shellock FG, Rezai AR. Permanent neurological deficit related to magnetic resonance imaging in a patient with implanted deep brain stimulation electrodes for Parkinson’s disease: case report. Neurosurgery 2005; 57: E1063.CrossRefPubMed
58.
Ostrem JL, Ziman N, Galifianakis NB, et al. Clinical outcomes using ClearPoint interventional MRI for deep brain stimulation lead placement in Parkinson’s disease. J Neurosurg 2016; 124: 908-16.CrossRefPubMed
59.
60.
Moscarillo FM, Annunziata CM. ECT in a patient with a deep brain-stimulating electrode in place. J ECT 2000; 16: 287-90.CrossRefPubMed
61.
Chou KL, Hurtig HI, Jaggi JL, Baltuch GH, Pelchat RJ, Weintraub D. Electroconvulsive therapy for depression in a Parkinson’s disease patient with bilateral subthalamic nucleus deep brain stimulators. Parkinsonism Relat Disord 2005; 11: 403-6.CrossRefPubMed
62.
Bailine S, Kremen N, Kohen I, et al. Bitemporal electroconvulsive therapy for depression in a Parkinson disease patient with a deep-brain stimulator. J ECT 2008; 24: 171-2.CrossRefPubMed
63.
Miocinovic S, Somayajula S, Chitnis S, Vitek JL. History, applications, and mechanisms of deep brain stimulation. JAMA Neurol 2013; 70: 163-71.CrossRefPubMed
64.
65.
66.
Pollo C, Kaelin-Lang A, Oertel MF, et al. Directional deep brain stimulation: an intraoperative double-blind pilot study. Brain 2014; 137: 2015-26.CrossRefPubMed
67.
Butson CR, Cooper SE, Henderson JM, McIntyre CC. Patient-specific analysis of the volume of tissue activated during deep brain stimulation. Neuroimage 2007; 34: 661-70.CrossRefPubMed
68.
Frankemolle AM, Wu J, Noecker AM, et al. Reversing cognitive-motor impairments in Parkinson’s disease patients using a computational modelling approach to deep brain stimulation programming. Brain 2010; 133: 746-61.CrossRefPubMedPubMedCentral
Metadata
Title
Anesthesia considerations for patients with an implanted deep brain stimulator undergoing surgery: a review and update
Authors
Tze Yeng Yeoh, MBChB
Pirjo Manninen, MD
Suneil K. Kalia, MD, PhD
Lashmi Venkatraghavan, MD
Publication date
01-03-2017
Publisher
Springer US
Published in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 3/2017
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-016-0794-8

Other articles of this Issue 3/2017

Canadian Journal of Anesthesia/Journal canadien d'anesthésie 3/2017 Go to the issue

Correspondence

Multifidus cervicis plane block is effective for cervical spine surgery

Book and New Media Reviews

Drugs in Anaesthesia and Intensive Care: Fifth Edition

Reports of Original Investigations

The effect of verbal and video feedback on learning direct laryngoscopy among novice laryngoscopists: a randomized pilot study

Correspondence

Life-threatening lingual artery hemorrhage after cardiac surgery

Reports of Original Investigations

Outcomes of elderly critically ill medical and surgical patients: a multicentre cohort study

Correspondence

Thermal softening of polyvinyl chloride nasotracheal tubes: effect of temperature on tube navigability