Ketamine for Conscious Sedation in Deep Brain Stimulation Surgery

For many years, deep brain stimulation (DBS) surgery has been performed in “awake” patients with local anesthesia, only. The purpose of keeping patients awake is to enable optimum microelectrode recordings for verification of target localization and to clinically assess the therapeutic stimulation window with intra-operative stimulation at the target. When imaging and operative techniques and technology improved over the years, the necessity of “awake” surgery has been questioned. The main disadvantage of “asleep” surgery is the fact that commonly used sedatives and anesthetics significantly alter recorded brain signals, patient symptoms, and patient ability to cooperate with test stimulations. Most sedatives and anesthetics are therefore rather not suitable for this neurosurgical procedure. Here, we describe our long-term study and practical experience with DBS surgery under ketamine-induced conscious sedation (Kornilov et al). We would like to offer a sedative regime combing propofol with subanesthetic dose ketamine as a compromise between “awake” and “asleep” DBS.