Choice of sedative for deep brain stimulation in Parkinson’s disease: Our experience and comparison of two cases

Introduction
Parkinson’s disease (PD) is a severe, debilitating disease of the extra pyramidal central nervous system, which has a significant effect on lifestyle and day to day living of the affected population. Statistically, more of the elderly are now going to present with this disease. Moving ahead from older procedures such as cingulotomy, pallidotomy and thalamotomy which had irreversible side effects, deep brain stimulation (DBS) has emerged as a new, safer and more attractive option for such patients. Anaesthetic concerns for such procedures mainly incorporate principles of awake craniotomy, for which the basic requirement is a cooperative patient. Although Propofol was somewhat of a gold standard for this purpose until a few years back, Dexmedetomidine has emerged as the new drug of choice.
Case
While conducting two surgeries for DBS over two days, we had an obverse experience with these drugs. We describe the pre-operative assessment and intra-operative management of the two cases and a discussion of the factors which might have contributed to this contradiction.
Conclusion
The choice of sedation for DBS in PD should take into consideration factors such as patient cooperation, ‘drug off’ state due to pre-op medication stoppage, GABA versus non-GABA mediated mechanism of drugs, amount of dependence on PD drugs, severity of disease and finally requirement of the testing team. No drug can be singled out to be better and must be chosen based on individual merits of the patient and disease.