Category: Surgical Therapy: Parkinson's Disease
Objective: To describe the use of hypnosis as an adjunct to local anesthetic during placement of deep brain stimulator (DBS)
Background: DBS has become commonplace for the control of symptoms of Parkinson’s disease (PD). Electrode placement in the awake patient allows realtime evaluation of the appropriateness of electrode location via intraoperative stimulation with evaluation of response. Patients and surgeons often prefer pharmacologic sedation during surgical exposure and closure. Pitfalls can arise during deep sedation in this patient population; autonomic dysfunction, common in PD patients, can predispose them to gastroparesis and aspiration, and to wide swings in blood pressure during infusion of sedating medications. Patients may also become disinhibited, disoriented, or combative at various planes of anesthesia. In addition, the patient’s airway is typically far from the anesthesia care team during DBS placement, making airway management difficult should it be required. Methods to minimize sedation and preserve airway reflexes and cardiovascular stability can be challenging in patients without an instrumented airway. Patient safety must be balanced with their comfort, to minimize movement while maintaining cardiovascular stability. Here we describe a 51-year-old man with claustrophobia, PD refractory to medication, and a distant history of polysubstance abuse who wished to avoid addictive drugs.
Method: Given his young age, lack of cognitive defects, and motivation to avoid potential drugs of abuse, the patient was deemed to be a good candidate for surgery under hypnosis. A brain MRI for surgical planning was obtained under hypnosis. DBS placement was later performed under local anesthesia and hypnosedation/hypnoanesthesia. No reflexive or volitional responses were noted during injection of local anesthesia or incision. The patient did open his eyes and appear uncomfortable during burr hole creation.
Results: At the conclusion of surgery, the only negative comment that the patient had was that he was disturbed by the ‘crunching’ he heard during final bone work.
Conclusion: Hypnosis is a viable option in DBS placement for patients motivated to avoid pharmacologic sedation, and who are highly susceptible to hypnosis. Next steps include refining the hypnosis script to prepare patients for the more stimulating portions of the procedure, and to develop a care map to bring patients from pre-operative planning through discharge. Case previously presented at NCSA 2021
To cite this abstract in AMA style:I. Cohen, D. Englert, M. Henegar, J. Rayner, K. Gamble, S. Patel. Hypnosis for Deep Brain Stimulator Surgery [abstract]. Mov Disord. 2023; 38 (suppl 1). https://www.mdsabstracts.org/abstract/hypnosis-for-deep-brain-stimulator-surgery/. Accessed March 2, 2024.
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MDS Abstracts - https://www.mdsabstracts.org/abstract/hypnosis-for-deep-brain-stimulator-surgery/