Awake versus Asleep Anesthesia in Deep Brain Stimulation Surgery for Parkinson's Disease: A Systematic Review and Meta-Analysis.

INTRODUCTION: Deep brain stimulation (DBS) is a well-established surgical therapy for patients with Parkinsons' Disease (PD). Traditionally, DBS surgery for PD is performed under local anesthesia, whereby the patient is awake to facilitate intraoperative neurophysiological confirmation of the intended target using microelectrode recordings. General anesthesia allows for improved patient comfort without sacrificing anatomic precision and clinical outcomes. METHODS: We performed a systemic review and meta-analysis on patients undergoing DBS for PD. Published randomized controlled trials, prospective and retrospective studies, and case series which compared asleep and awake techniques for patients undergoing DBS for PD were included. A total of 19 studies and 1,900 patients were included in the analysis. RESULTS: We analyzed the (i) clinical effectiveness - postoperative UPDRS III score, levodopa equivalent daily doses and DBS stimulation requirements. (ii) Surgical and anesthesia related complications, number of lead insertions and operative time (iii) patient's quality of life, mood and cognitive measures using PDQ-39, MDRS, and MMSE scores. There was no significant difference in results between the awake and asleep groups, other than for operative time, for which there was significant heterogeneity. CONCLUSION: With the advent of newer technology, there is likely to have narrowing differences in outcomes between awake or asleep DBS. What would therefore be more important would be to consider the patient's comfort and clinical status as well as the operative team's familiarity with the procedure to ensure seamless transition and care.

Lance Adams Syndrome After Hypoxic Cardiac Arrest: A Case Report.

Lance-Adams syndrome (chronic post-hypoxic myoclonus) is a rare syndrome occurring in patients after cardiopulmonary resuscitation. Awareness of this condition is important to distinguish it from myoclonic status epilepticus, which is a poor prognostic sign. We present the case of a 32-year-old woman who developed Lance-Adams syndrome after an episode of hypoxic cardiac arrest from severe pneumonia. Brain computed tomography, magnetic resonance imaging, and an electroencephalogram were used to rule out other causes of myoclonus. In this report, we discuss the diagnosis, treatment, and prognosis of patients with Lance-Adams syndrome.

Provision of emergency hyperbaric oxygen treatment for a patient during the COVID-19 pandemic.

The experience of managing a critically ill severe carbon monoxide poisoning patient suspected of possibly also suffering COVID-19 and requiring emergency hyperbaric oxygen treatment is described. Strategies used to minimise infection risk, modifications to practice and lessons learnt are described. All aerosol generating procedures such as endotracheal tube manipulation and suctioning should be undertaken in a negative pressure room. In the absence of in-chamber aerosol generating procedures, an intubated patient presents less risk than that of a non-intubated, symptomatically coughing patient. Strict infection control practices, contact precautions, hospital workflows and teamwork are required for the successful HBOT administration to an intubated COVID-19 suspect patient.