Deep Brain Stimulation (DBS) Sedation
Condition: Brain; Sedation
Intervention: Remifentanil; Propofol; Dexmedetomidine
Intervention description: Remifentanyl will be administered for 10 -15 minutes before initiating the MER phase and the patient will be allow to wake up and the bispectral index (BIS) values to normalize to awake level for the MER.; Propofol will be administered for 10 -15 minutes before initiating the MER phase and the patient will be allow to wake up and the BIS values to normalize to awake level for the MER.; Dexmedetomidine will be administered for 10 -15 minutes before initiating the MER phase and the patient will be allow to wake up and the BIS values to normalize to awake level for the MER.
Intervention MeSH terms: Dexmedetomidine; Remifentanil; Propofol
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Non-Randomized
Intervention model: Sequential Assignment
Masking: None (Open Label)
Enrollment: 20.0
Sex: All
Minimum age: 18 Years
Maximum age: 85 Years
Healthy volunteers: No
Keywords: Deep Brain Stimulation(DBS); Sedation; DBS Implantation; Microelectrode recording(MER)

Summary:

      Deep brain stimulation (DBS) of different brain nuclei is a treatment for multiple brain
      disorders. The subthalamic nucleus (STN) and globus pallidus have been used to treat advanced
      Parkinson's disease for a long time. The ventral intermediate nucleus of the thalamus is an
      effective target for treating essential tremor patients. STN and the internal segment of the
      globus pallidus are useful targets for treating dystonia.

      To achieve this optimal electrode localization, many centers perform electrophysiological
      mapping of the target nuclei using microelectrode recording (MER). This way they can achieve
      precise localization of the electrode. During the mapping procedure, microelectrodes are
      passed through the target nuclei, and the electrical neuronal activity is observed and
      recorded. The surgical team can identify the precise location of the target nuclei and its
      borders according to the typical activity of its neurons.

      This study will compare the activity of neurons in several DBS targets before, during and
      after sedation with propofol, remifentanil and dexmedetomidine. The goal is to understand the
      effects of anesthetics on the neuronal activity in these targets, allowing us to choose the
      most appropriate sedation protocol to use during implantation of DBS electrodes in deep brain
      structures (bearing in mind that each structure may have a different optimal protocol).
    

Eligibility criteria:

        Inclusion Criteria:

          -  All patients scheduled to undergo DBS electrode implantation surgery with MER that
             agree to participate in the experiment and sign an informed consent are candidates to
             participate in the study, unless one of the exclusion criteria is met

        Exclusion Criteria:

          1. Known or suspected obstructive sleep apnea.

          2. Suspected difficult intubation.

          3. Pregnancy (pregnancy test is standard care for women of childbearing age)

          4. Under 18 years of age or over 85 years of age

          5. Cognitive disability impairing understanding the experiment or signing the informed
             consent form.