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Dear List-friends: On Dec. 30, Margaret Tuchman passed on to us two messages from Dr. Ken Janis, who wrote of his concern over the dearth of information about the combination of PD and Anesthetic management. In the past, and currently, list members have shared problems and horror stories relating to the combination of PD and drugs used during surgery. Just now this is very much on my mind. My husband waits for the results of MRI, bone scans, X- rays, and the combined wisdom of neurologist, Orthopedist, and family doctor, to find out if he will need surgery to alleviate whatever it is that has so painfully, and suddenly immobilized him. He has already stopped taking Eldepryl, but what about all the other drugs he is taking? How will these interact with the drugs used? There are a couple of other factors that have to be considered as well. His age (76) is one. Many of the drugs used during surgery carry warnings that the dose should be reduced for the elderly patient. Another factor is his weight (122 pounds). Patients with relatively low weight and lean body mass cannot tolerate the normal adult doses of many drugs. This is considered by anesthesiologists, but it is not always easy to titrate doses for these patients. I recall that in 1945, when I had my first experience with a general anesthetic, the nurse clapped a chloroform mask over my nose and I went to sleep. With several subsequent surgeries, I gave no thought to the process of anesthesia, being more concerned with the fellow with the knives. Then, in 1987, for the first time, I received an itemized bill for every item used in the process of removing my gall bladder. This list included every drug used during surgery. What an eye-opener! Things weren't so simple any more, and I imagine they have gotten more complex since. My list included atropine, Anectine, Tubo-cuarine, Demerol, Versed, Lidocaine, Narcan, Sublimaze, and Vistaril. Each serves a specific purpose. Some selectively deepen narcosis, others bring one back from it. One is effective at blocking memory of peri-op activities. One is an anticholinergic. Some relax muscles, others calm and tranquilize. Today's Anesthesiologist is like the conductor of an orchestra, manipulating various body functions while the surgical team does their work. All are powerful, dangerous drugs. Their PDR entries include the usual numerous warnings. I've never had any trouble with anesthetics, but I don't have PD. If Neal has to have surgery, I would feel a whole lot better if more data were available about how PD patients are likely to fare. If it comes to surgery, my biggest problem will be to make sure everyone concerned understands the problems presented by advanced Parkinsonism. >From the messages shared here, I realize that isn't always easy. Martha (CG for Neal, 76/11)