© Springer International Publishing Switzerland 2015
Molly Blackley Jackson, Somnath Mookherjee and Nason P. Hamlin (eds.)The Perioperative Medicine Consult Handbook10.1007/978-3-319-09366-6_2626. Parkinson’s Disease
(1)
Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
Background
Patients with Parkinson’s disease are at increased risk for perioperative complications [1]. In a prospective study of perioperative complications, patients with Parkinson’s disease were at significantly higher risk for all serious complications after correcting for other risk factors in a multivariate analysis (odds ratio 8.14, CI 1.76–37.67) [2]. Patients are generally thought to be at increased risk because of difficulty with mobility, swallowing, and decreased pulmonary reserve made worse if they miss medication doses in the perioperative period. These patients are also at increased risk for gastric dysmotility, orthostatic hypotension, delirium, and falls. There is no broad consensus statement or treatment guidelines for the perioperative approach to this disease [3]. However, many perioperative complications of Parkinson’s disease can potentially be reduced by minimizing interruptions in Parkinson’s disease medications [3].
Preoperative Evaluation
Take a detailed history and perform an exam with particular focus on:
Typical symptoms and signs related to the patient’s Parkinson’s disease
Exact medication use including dosing and time of administration
Typical reaction if the patient misses a dose [3]
Whether the patient has a deep brain stimulator
Patients with Parkinson’s tend to show a restrictive type picture on pulmonary function testing related to rigidity and bradykinesia of the respiratory muscles. In many patients this is improved by treatment with levodopa [4]. It is important to be aware that patients may be at increased risk for perioperative pulmonary complications, but it is not necessary to routinely obtain pulmonary function tests (PFTs) before surgery. Alert the anesthesiologist if the patient has a deep brain stimulator as the anesthesiologist may need to plan for coordinating with the device’s programmer to temporarily turn it off during surgery.
Perioperative Management
Medication Management
Attempt to keep the timing of the patient’s Parkinson’s medication regimen the same as the outpatient regimen [3]. Patients may be very sensitive to the exact timing of their doses of some medications, including carbidopa/levodopa.
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