Considerations for general anaesthesia in Parkinson’s disease

Parkinson Disease, Dysphagia, and Cervical Spine Surgery

“…It is well known that PD patients are at increased risk of complications from anesthesia. 13 The association of dysfunction of laryngeal muscles causing laryngeal spasms during anesthesia may precipice aspiration leading to aspiration pneumonia. 14,15 Hence it is important to perform an adequate preoperatively and intraoperatively anesthetic management to limit complications in this population.…”

“…14,15 Hence it is important to perform an adequate preoperatively and intraoperatively anesthetic management to limit complications in this population. 13 Preoperatively a chest x-ray and pulmonary function test should be considered, intraoperatively certain medication side effects should be considered for example propofol can induce dyskinesia and dystonic reactions 16 which can lead to aspiration. 13 A good practice, given the short half-life of levodopa, is to place patients with PD as a first start of the surgical day to then have a shorter fasting time and time off levodopa.…”

The Role of Minimally Invasive Spinal Surgical Procedures in the Elderly Patient: An Analysis of 49 Patients Between 75 and 95 Years of Age

“…Patients with Parkinson's disease are more prone to falls and spinal fractures and maybe more rigid which may affect surgical positioning [28]. Although extremity tremors may be present, usually this does not interfere with procedures but they may be very sensitive to general anesthesia as well as medication used in light sedation anesthesia [29]. It is important to understand that even mild to moderate sedation used with local anesthesia carries risks, and can lead to post-operative somnolence and cognitive problems in elderly patients.…”

Treatment paradigms in Parkinson's Disease and Covid-19

“…Interestingly, levodopa has been found to strengthen diaphragm contraction in anesthetized dogs and patients with chronic obstructive pulmonary disease (COPD) and acute respiratory dysfunction ( Aubier et al, 1989 ; Fujii, 2006 ). Maintaining the standard regimen would also lower the risk of parkinsonism-hyperpyrexia syndrome in case of abrupt cessation or decrease in levodopa equivalent dose; insertion of a nasogastric tube is highly recommended to allow administration of antiparkinsonian medication ( Roberts & Lewis, 2018 ). Of note, enteral nutrition with high protein-enriched supplements, commonly used in the ICU, was found to constitute an independent risk factor for parkinsonism-hyperpyrexia syndrome, as dietary protein might compromise the absorption of levodopa ( Bonnici, Ruiner, St-Laurent, & Hornstein, 2010 ).…”

“…Of note, enteral nutrition with high protein-enriched supplements, commonly used in the ICU, was found to constitute an independent risk factor for parkinsonism-hyperpyrexia syndrome, as dietary protein might compromise the absorption of levodopa ( Bonnici, Ruiner, St-Laurent, & Hornstein, 2010 ). Proper levodopa dosing is also expected to minimize the risk of rigidity and distress on emergence of anesthesia ( Roberts & Lewis, 2018 ). For PwP under infusion therapies, it is advised for these therapies to be continued ( Fasano, Antonini, et al, 2020 ).…”