Patients with Parkinson's disease seem prone to developing postoperative delirium after surgery, the causes of which remain understudied and multifactorial. Anesthetic management remains challenging due to the changes in neurotransmitter levels in these patients which translate to altered drug effects. Avoiding excessive anesthesia is essential. Processed electroencephalography (EEG) is used worldwide along with our centre to monitor depth of anesthesia. It is non-invasive and easy to use. Some EEG patterns like "burst suppression" are easily identifiable and indicate that the brain has fallen into an excessively low metabolic state, which could mean increased anesthetic sensitivity. Appearance of "burst suppression" can predict delirium in non-neurosurgical procedures, but this has never been studied during surgery for deep brain stimulator insertion in Parkinson's disease patients. Through this study we wish to observe the association of EEG parameters with the development of postoperative delirium in this subset of the population.This has the capacity to change anesthetic practice by being mindful of the fragile brain of such patients and individualizing drug dosing for each patient to improve outcomes and reduce hospital stay.
Diagnosis of Parkinson's disease
Elective neurosurgery for implantation of DBS electrodes and implantable pulse generator (IPG) device.
18 years of age or older
Refusal/withdrawal of consent
Inability to place sensor/ record EEG for the entire duration of surgery
Emergency surgery
Redo surgery
Patients 18 years of age or older who have been diagnosed with Parkinson's Disease and are undergoing elective neurosurgery for implantation of DBS electrodes and implantable pulse generator (IPG) device.
Cohort
Prospective
EEG (electroencephalogram) monitoring of Parkinson's patients undergoing deep brain stimulation
Other interventionParkinson's patients undergoing deep brain stimulation (DBS) will be monitored with EEG to detect burst suppression signals during surgery and will undergo postoperative cognitive testing for postoperative delirium.
Identification and quantification of the association between the presence of intraoperative burst suppression with the incidence of postoperative delirium
Identification and quantification of the association between the presence of intraoperative burst suppression with the incidence of postoperative delirium. This will be measured by evaluating the presence of burst suppression readings found during intraoperative EEG monitoring and determining whether the readings are associated with the development of postoperative delirium (measured by the administration of the 3D CAM and MoCA tools).
Determining the association of postoperative delirium with other parameters on perioperative processed EEG
EEG readings will be assessed to determine if duration (minutes) of burst suppression, peak frontal alpha power, and duration (minutes) of patient state index (PSI) are associated with the development of postoperative delirium (measured by the administration of the 3D CAM and MoCA tools).
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