7. Ketamine Sedation During DBS In Pediatric Patients with DYT1

1. Dept. of Neurosurgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel.

2. Dept. of Anesthesia, Hadassah Hebrew University Medical Center, Jerusalem, Israel.

3. The Edmond and Lily Safra Center for Brain Research (ELSC), The Hebrew University of Jerusalem, Jerusalem, Israel.

4. Dept. of Medical Neurobiology (Physiology), Institute of Medical Research Israel Canada (IMRIC), the Hebrew University Hadassah Medical School, Jerusalem, Israel

Deep Brain Stimulation (DBS) of the Globus Pallidus Interna (GPi) is an established surgical treatment for pediatric patients with DYT1 Dystonia. Because of their young age the surgery is performed under general anesthesia which limits the ability to perform microelectrode recording (MER). A previous study that we performed on parkinsonian monkeys showed that among different sedative drugs, Ketamine has the least negative effect on the neuronal activity of the basal ganglia.

In four pediatric patients with DYT1 Dystonia, we used a novel anesthetic strategy in order to enable MER of the GPi during asleep DBS surgery. All patients were intubated and received N₂O (65-70%) during the entire procedure. Propofol (20-25 ml/hour) was used during the non-recording stages of the surgery. Toward the recording stage of the surgery, the Propofol was stopped and the patient received a bolus of Ketamine (0.5 mg/kg). The depth of anesthesia was monitored using entropy.

In all eight trajectories we were able to identify an electrophysiological activity stereotypical for the GPi. No anesthetic or surgical complications were observed.

We present here a ketamine-based anesthetic strategy for asleep DBS surgery. This novel method enables microelectrode recording of the GPi in pediatric patients with DYT1 Dystonia. This work is an example for the importance of a tight collaboration between clinicians and researchers, and for the ability to apply basic science findings into medical practice.