irrigate with Bacitracin / vancomycin DuraSeal on whole plastic to prevent CSF leak. bur hole incision: close with 4-0 Vicryls for galea staples Aquacel Ag dressing (historically: → → Mepilex Ag→ Tegaderm). connector incision: 1-2 full thickness vertical mattress 2-0 nylons staples Aquacel Ag dressing → → bone fiducials removed and irrigated out with vancomycin (Dermabond staples (Monocryl for → →) frontal ones) bacitracin → stockinette. take to CT scanner (check for bleeding, lead placement, pneumocephalus) / do enhanced mode scan with O-arm. resume immediately postoperatively (also will help a little bit with HTN Parkinsonian medications BP; Dr. Baron says that Sinemet does not affect BP much); if frozen, OK to give extra dose of Sinemet. keep SBP < 155 for overnight or 24 hours (if requires PRN meds for BP, keep in ICU overnight), then relax parameters. NR mask for 24 hrs if large pneumocephalus. mupirocin ointment to bone fiducial sites TID. home after 24 hours if no problem. may be difficult with demented, frail patients. strongly consider doing awake second side accuracy may be compromised due to pneumocephalus, – so desirable to verify effects with patient awake. MER general anesthesia without muscle paralysis. on radiolucent headrest, egg crate (to prevent pressure sores), but no C-collar EMG monitoring in contralateral orbicularis oculi, orbicularis oris, arm, ± leg i.e. internal capsule – side effects: implant to target depth and increase voltage until EMG shows response, then try different contacts and wide array. DBS Only with patient awake!
irrigate with Bacitracin / vancomycin DuraSeal on whole plastic to prevent CSF leak. bur hole incision: close with 4-0 Vicryls for galea → staples → Aquacel Ag dressing (historically: Mepilex Ag→ Tegaderm). connector incision: 1-2 full thickness vertical mattress 2-0 nylons → staples → Aquacel Ag dressing bone fiducials removed and irrigated out with vancomycin → (Dermabond →) staples (Monocryl for frontal ones) → bacitracin stockinette. take to CT scanner (check for bleeding, lead placement, pneumocephalus) / do enhanced mode scan with O-arm. resume Parkinsonian medications immediately postoperatively (also will help a little bit with HTN BP; Dr. Baron says that Sinemet does not affect BP much); if frozen, OK to give extra dose of Sinemet. keep SBP < 155 for overnight or 24 hours (if requires PRN meds for BP, keep in ICU overnight), then relax parameters. NR mask for 24 hrs if large pneumocephalus. mupirocin ointment to bone fiducial sites TID. home after 24 hours if no problem. may be difficult with demented, frail patients. strongly consider doing awake – second side accuracy may be compromised due to pneumocephalus, so desirable to verify effects with patient awake. MER general anesthesia without muscle paralysis. on radiolucent headrest, egg crate (to prevent pressure sores), but no C-collar EMG monitoring in contralateral orbicularis oculi, orbicularis oris, arm, ± leg – i.e. internal capsule side effects: implant to target depth and increase voltage until EMG shows response, then try different contacts and wide array. DBS Only with patient awake!
Op360.%20DBS.docx