Original Research

Fagerlund, Kathleen; Anderson, Lisa; Gurvich, Olga V

doi:10.1097/01.naj.0000425744.76107.9f

Cited by 13 publications

(2 citation statements)

References 10 publications

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“…A retrospective analysis of 89 separate surgical events for 67 discrete PD patients revealed a median withholding duration of 12.35 h for carbidopa-levodopa (C/L). 17 The median withholding duration was longer for inpatient procedures (16.75 h) than for the outpatient procedures (11.38 h). In the same study, 62% of the surgeries resulted in medication withholding duration between 10 and 20 h and 17% of the surgeries resulted in withholding times of >20 h. 17 The physician should consider allowing the administration of PD medications as close as possible to the patient's medication schedule preoperatively.…”

Section: Addressing the Nms During The Hospital Staymentioning

confidence: 91%

“…17 The median withholding duration was longer for inpatient procedures (16.75 h) than for the outpatient procedures (11.38 h). In the same study, 62% of the surgeries resulted in medication withholding duration between 10 and 20 h and 17% of the surgeries resulted in withholding times of >20 h. 17 The physician should consider allowing the administration of PD medications as close as possible to the patient's medication schedule preoperatively. Scheduled surgery should ideally happen early in the day to promote the best symptom management and limit the risk of complications and discomfort related to missed doses.…”

Section: Addressing the Nms During The Hospital Staymentioning

confidence: 91%

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A Pragmatic Approach to the Perioperative Management of Parkinson’s Disease

Lenka

Mittal²,

Lamotte

et al. 2020

Can. J. Neurol. Sci.

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Patients with Parkinson’s disease (PD) may undergo several elective and emergency surgeries. Motor fluctuations, the presence of a wide range of non-motor symptoms (NMS), and the use of several medications, often not limited to dopaminergic agents, make the perioperative management of PD challenging. However, the literature on perioperative management of PD is sparse. In this descriptive review article, we comprehensively discuss the issues in the pre-, intra-, and postoperative phases which may negatively affect the PD patients and discuss the approach to their prevention and management. The major preoperative challenges include accurate medication reconciliation and administration of the dopaminergic medications during the nil per os (NPO) state. While the former can be addressed with staff education and PD-specific admission protocols, knowledge of non-oral formulations of dopaminergic agents (apomorphine, inhalational levodopa, and rotigotine transdermal patch) is the key to the management of the Parkinsonian symptoms in NPO state. Deep brain stimulation (DBS) devices should be turned off to avert potential electromagnetic interference with surgical appliances. Choosing the appropriate anesthesia and avoiding and managing respiratory issues and dysautonomia are the major intraoperative challenges. Timely reinitiation of dopaminergic medications, adequate management of pain, nausea, and vomiting, and prevention of postoperative infections and delirium are the postoperative challenges. Overall, a multidisciplinary approach is pivotal to prevent and manage the perioperative complications in PD. Administration of anti-Parkinson medications during NPO state, prevention of anesthesia-related complications, and timely rehabilitation remain the key to healthy surgical outcomes.

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Section: Addressing the Nms During The Hospital Staymentioning

confidence: 91%

Section: Addressing the Nms During The Hospital Staymentioning

confidence: 91%

A Pragmatic Approach to the Perioperative Management of Parkinson’s Disease

Lenka

Mittal²,

Lamotte

et al. 2020

Can. J. Neurol. Sci.

View full text Add to dashboard Cite

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Perioperative Use of Intravenous Levodopa as an Anti‐Parkinsonian Drug: A Propensity Score Analysis

Kodama,

Jo,

Yasunaga

et al. 2023

Movement Disord Clin Pract

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BackgroundPerioperative discontinuation of oral anti‐parkinsonian medication can negatively impact the prognosis of abdominal surgery in patients with Parkinson's disease. Although intravenous levodopa may be an alternative, its efficacy has not yet been investigated.ObjectivesTo determine the efficacy of intravenous levodopa as an alternative to oral anti‐Parkinsonian drugs during gastric or colorectal cancer surgery.MethodsWe identified patients with Parkinson's disease who underwent surgery for gastric or colorectal cancer between April 2010 and March 2020, using the Diagnosis Procedure Combination database, a nationwide inpatient database in Japan. Patients were divided into two groups: those who received intravenous levodopa during the perioperative period and those who did not. We compared in‐hospital mortalities, major complications, and postoperative length of stay between the groups after adjusting for background characteristics with overlap weights based on propensity scores.ResultsWe identified 648 patients who received intravenous levodopa and 1207 who did not receive levodopa during the perioperative period. In the adjusted cohort, the mean postoperative length of stay was 24.7 and 29.0 days (percent difference, −7.7%; 95% confidence interval, −13.1 to −1.5); in‐hospital death was 3.2% and 3.3% (adjusted odds ratio, 0.95; 95% CI: 0.54–1.67); and incidence of major complications were 21.4% and 19.3% (adjusted odds ratio, 0.89; 95% confidence interval, 0.70–1.13) in those with and without intravenous levodopa, respectively.ConclusionsIntravenous levodopa was associated with a shorter postoperative length of stay, but not with mortality or morbidity. Intravenous levodopa may improve perioperative care in patients with Parkinson's disease.

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Adherence to a strict medication protocol can reduce length of stay in hospitalized patients with Parkinson's Disease

Azmi

Cocoziello

Nyirenda

et al. 2020

Clinical Parkinsonism & Related Disorders

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Background Patients with Parkinson's Disease (PD) are at higher risk of complications when admitted to the hospital. Delays in PD medications and use of contraindicated medications contribute to the increased risk and prolong their lengths of stay (LOS). Using a hospital-wide PD protocol, we aimed to ensure PD medications were placed with “custom” timing to resemble the home schedules, and also to avoid ordering or administering contraindicated medications. Material and methods 569 patients admitted in 2017 and 2018, were reviewed retrospectively. Mean age was 76.5 (SD 10.6), 332 were males and 237 were females. Charts were reviewed to assess if A) PD medications were ordered with custom timing, B) if not, were the orders changed to custom timed C) if contraindicated medications were ordered, and D) if they were administered. We also assessed the actual/expected length of stay during this time period. Chi Square and post hoc analyses were done to compare time points. Poisson regression analysis was done to assess relative improvement of variables. Results There was a 2.7 fold increase in orders placed with custom timing in 2018 compared to 2017 (RR = 2.651, 95%CI: 1.860–3.780, p < 0.0001), and a 3.2 fold increase in correction of non-custom orders in the same time period (RR = 3.246, 95%CI: 1.875–1.619, p < 0.0001). We also observed a decrease in the actual/expected LOS ratio from 1.54  to 1.32  (p < 0.05). Conclusion By utilizing an established platform for quality improvement, we were able to improve adherence to the home medication regimen timing in admitted PD patients. Our findings also suggests that adherence to a strict medication regimen protocol may decrease LOS for this patient population.

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Original Research

Cited by 13 publications

References 10 publications

A Pragmatic Approach to the Perioperative Management of Parkinson’s Disease

A Pragmatic Approach to the Perioperative Management of Parkinson’s Disease

Perioperative Use of Intravenous Levodopa as an Anti‐Parkinsonian Drug: A Propensity Score Analysis

Adherence to a strict medication protocol can reduce length of stay in hospitalized patients with Parkinson's Disease

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