Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is widely used in the treatment of Parkinson’s disease. DBS surgery is usually performed with the patient under local anesthesia (LA). However, a number of patients do not tolerate LA due to anxiety or severe pain. These patients require surgery under sedation or general anesthesia. Unfortunately, anesthetic drugs interfere with the intraoperative microelectrode recordings. A debate regarding the usefulness of sedation or general anesthesia during DBS surgery is still in progress. In this study, we evaluated whether the differences in anesthetic methods affect STN single-unit activity and movement symptoms of Parkinson’s disease. Eight patients underwent surgery to implant bilateral STN DBS electrodes. Our study compares STN single-unit activity under both LA and monitored anesthesia care (MAC) in the same patients as well as movement symptoms of Parkinson’s disease. The primary results revealed no significant difference in the mean firing rate of STN single-unit activity under LA and MAC. However, there were differences in the spike characteristics and firing patterns of STN activity between the two anesthetic methods. These findings contribute valuable insight into the effects of different anesthetic methods on STN single-unit activity for precise electrode localization during DBS surgery.