Deep brain stimulation surgery under ketamine induced conscious sedation: a double blind randomized controlled trial
Notice bibliographique
Résumé
Abstract Background The gold standard anesthesia for deep brain stimulation (DBS) surgery is the “awake” approach, using local anesthesia alone. While it offers high-quality microelectrode recordings and clinical assessment of the stimulation therapeutic window, it potentially causes patients extreme stress and might result in suboptimal surgical outcomes. However, the alternative of general anesthesia or deep sedation dramatically reduces reliability of physiological navigation and therapeutic window assessment, thus potentially diminishing the accuracy of lead localization. We therefore designed a prospective double-blinded randomized controlled trial to investigate a novel anesthesia regimen of ketamine-induced conscious sedation for DBS surgery. Methods Patients with Parkinson’s disease undergoing subthalamic nucleus DBS surgery were enrolled. Patients were randomly assigned to either the experimental or control group. During the physiological navigation phase, the experimental group received ketamine infusion at a dosage of 0.25 mg/kg/hr, while the control group received normal saline. Both groups received moderate propofol sedation before and after the physiological navigation phase. Primary outcomes were non-inferiority of electrophysiological quality, including multiunit recordings, EEG, EMG, bispectral index and lead localization accuracy according to postoperative CT scans. Secondary outcomes included patients’ satisfaction level measured using Iowa satisfaction with anesthesia scale for awake procedures. Potential side effects and adverse events were also monitored, including hemodynamics (blood pressure, heart rate) and cognition (hallucinations during surgery and early post-operative cognition using Montreal Cognitive Assessment). Results Thirty patients, 15 from each group, were included in the study and analysed. Intra-operatively, the electrophysiological signature of the subthalamic nucleus was similar under ketamine and saline. Tremor amplitude was slightly lower under ketamine ( p = 0.002). The accuracy of lead position was comparable in both groups. Postoperatively, patients in the ketamine group reported significantly higher satisfaction with anesthesia. The improvement in Unified Parkinson’s disease rating scale part-III was similar between the groups. No negative effects of ketamine on hemodynamic stability or cognition were reported perioperatively. Additionally, no procedure-related complications were reported in either group, besides one case of peri-lead edema in the control group. Conclusion This study demonstrates that ketamine induced conscious sedation during physiological navigation in DBS surgery resulted in non-inferior intra-operative, post-surgical and patient satisfaction outcomes compared to the commonly used standard awake protocol, without major disadvantages. Future studies should investigate the applicability of this protocol in other awake neurosurgical procedures, such as DBS for other targets and indications, and awake craniotomy for tumor resection and epilepsy.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,007 | 0,002 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,002 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».