Objective: To evaluate any difference in the clinical outcome under GA and MAC of STN DBS surgery

Background: Traditionally, DBS surgery is performed under MAC for lead implantation .The advantage is that it can improve the accuracy of lead implantation, as patient is awake to perform intra-operative clinical testing. However, it requires significant cooperation from patients, both physically and psychologically. With improving DBS targeting technology, the worldwide trend is to performing surgery under GA, which makes patient more comfortable. Since 2018 , we set up a protocol for STN-DBS surgery under GA .The study was to compare the clinical result  under GA from 2018 to 2022 with our previous result  under MAC since 2016. The aim was to see if DBS under GA can achieve better or at least non inferior result comparing with that of under MAC .

Method: DBS registry (Protocol driven prospectively data collection) of all PD patients receiving STN-DBS from 2016 to 2022 were analysed. The patients were divided into MAC and GA groups according to the type of anaesthesia they received for the lead implantation part of the operation. The percentage of improvement measured by the Unified Parkinson’s Disease Rating scale (UPDRS) part III and Levodopa Equivalents Dose (LED) at one-year post-operation were compared between two groups.

Results: There were 56 patients received STN DBS during 2016-2022. 3 patients were excluded form analysis due to [1] unavailable one-year outcome assessment at time of paper writing (MAC, N=2) ,and [2] post- operative complication ,intracranial haemorrhage (MAC, N=1) . Thus, a total of 22 patients received MAC and 31 patients received GA were analysed. There was no statistically differences on age, duration of disease and cognitive functions 

At one-year post- operation , UDPRS Part III when comparing medication OFF / DBS OFF versus medication OFF/DBS ON were 62 % and 55% improvement  in the MAC and GA group respectively. There was no statistical difference between two groups ( p=0.90) by using one-way ANOVA . The mean LED reduction percentage rate was 59% and 61%in the MAC and GA group respectively . Similarly, there was no statistical difference between two groups. ( p=0.830).

Conclusion: Efficacy of STN-DBS in terms of motor function was similar under MAC and GA.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/comparing-the-outcome-under-general-anaesthesia-ga-and-monitored-anesthesia-care-mac-of-subthalamic-nucleus-stn-deep-brain-stimulation-dbs-surgery-for-parkinsons-disease-pd-in-hon/