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Departments of *Anesthesiology and Intensive Care and
Neurosurgery, Toulouse University Hospital, Paul Sabatier University, Toulouse, France, vincentminville{at}yahoo.fr,
Department of Anesthesiology and Intensive Care, Henri Mondor University Hospital, Créteil, France
To the Editor:
Increasing numbers of patients with Parkinson's disease (PD) are being treated with an implanted cerebral stimulator (13). Anesthetic management of these patients is still a matter of debate (4,5). Regional anesthesia probably avoids exacerbation of PD (6). However, there are no data on whether the use of a nerve stimulator for regional anesthesia interferes with the function of the deep-brain stimulator.
We report the case of a 72-yr-old patient with a dislocated shoulder, who had deep-brain stimulators of the subthalamic nucleus (Kinetra; Medtronic, Minneapolis, MN) (Fig. 1) for a severe PD. Anesthesia was provided with a supraclavicular brachial plexus block, guided with a nerve stimulator. The Unified Parkinson Disease Rating Scale was at 28 before the surgery with axial dyskinesia and severe dysarthria. Before the procedure, the subthalamic stimulator setting was checked by the neurosurgical team. The stimulator ran throughout the procedure. Landmarks were not modified by the device, and the stimulation wires were palpated far from the puncture site. The tremor from PD did not interfere with monitoring or with placement of the block. After the procedure, the neurosurgical team reassessed the subthalamic stimulators, and found no change. The patient was discharged 2 days later from the hospital. No exacerbation of the PD was noticed (Unified Parkinson Disease Rating Scale at 28).
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In summary we report successful use of a nerve stimulator in a patient with advanced PD and deep-brain stimulators. We encountered no interference with deep-brain stimulation and no complications from our use of a nerve stimulator.
References
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