http://www.pharmacology2000.com/Central/General_Anesthesia/clincor2.htm#Parkinson's Disease
Parkinson's Disease-
Cause: loss of dopaminergic fibers in the basal ganglia, secondary
to nerve cell body destruction in the substantia nigra.
Some Drugs used in management of Parkinson's disease:
L-DOPA: dopamine precursor; often given in combination with carbidopa (Lodosyn), a
peripheral decarboxylase inhibitor
Direct dopamine (Intropin) receptor agonists: bromocriptine (Parlodel), pergolide
(Permax)
monoamine oxidase-B inhibitor: selegiline (Eldepryl)
Anesthesia Management: Parkinson's disease
Maintain normal Parkinson's disease medication through the morning of surgery
Avoid drugs that antagonize dopamine (Intropin) effects in the basal ganglia, e.g.
phenothiazines & butyrophenones (droperidol (Inapsine)
Alfentanil (Alfenta): may cause acute dystonic reactions in patients with untreated
Parkinson's disease.
In elderly patients with coronary vascular disease & Parkinson's disease: ketamine
(Ketalar) should be use with caution as it may induce tachycardia to & hypertension.
Parkinson's disease patients may be a greater risk for aspiration pneumonitis
because of autonomic dysfunction leading to excessive salivation, dysphagia, and
esophageal abnormalities.
The most common cardiovascular abnormality in Parkinson's disease patients is
orthostatic hypotension:
Parkinson's disease patients are more likely to exhibit hypotensive
reactions
in response to inhaled halogenated anesthetics
Postoperative: more susceptible to mental confusion & hallucinations-unknown mechanism.
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