Parkinson's disease poorly managed perioperatively
VANCOUVER, Aug 02, 1999 (Reuters Health) - Patients with Parkinson's
disease (PD) say that their disease is poorly managed in-hospital when
they undergo surgery for other conditions, investigators reported here
at the 13th International Congress on Parkinson's Disease.
Dr. David Stewart and colleagues at the Victoria Infirmary in Glasgow,
Scotland, analyzed the results of questionnaires completed by patients
with PD who underwent operations for unrelated conditions. Patients'
caregivers also filled out questionnaires.
The investigators obtained data from 125 procedures (neurologic,
ophthalmologic, orthopedic, urologic, and general surgery) undergone by
92 patients. Patients' mean age was 70.7 years, and the mean duration of
PD was 8.6 years.
Overall, patients and their caregivers said that they were unhappy with
the way PD was managed after 31% of the operations. Problems with
medication timing or omission after the operation were reported in 37
(30%) of the operations.
"A possible reason for the problems with medication timing or omission
is that patients' overall functioning can vary greatly throughout the
day, and a number of patients felt that the nurses could see that they
were capable of doing things for themselves at some point in the day,"
Dr. Stewart suggested. "What happens is that later on in the day when
patients were perhaps incapable of doing things for themselves and asked
the nurses for help, the nurses were sometimes suspicious and hesitant
to assist."
Of the 37 operations in which patients and caregivers cited problems
with drug timing or omission, 31 cases (84%) resulted in PD
complications compared with 32 of the 88 (36%) procedures in which no
problems were reported with drug administration.
Dr. Stewart said he is currently working on guidelines that will help
surgeons, anesthesiologists, and nurses on the perioperative management
of PD.
Elsewhere at the meeting, a group from the University of British
Columbia, in Vancouver, reported the results of a study of patients with
PD who were selected for unilateral pallidotomy based on their motor
symptoms. The study showed that the procedure significantly decreases
PD-related pain.
Overall, 42% of 50 patients described pain related to PD prior to
pallidotomy. Preoperative scores for pain were significantly reduced at
both 6 weeks and 1 year following pallidotomy.
The investigators identified four primary types of PD-related pain:
somatic pain exacerbated by the disease, musculoskeletal pain, pain
associated with dystonic movements, and dysesthetic pain. A few patients
had more than one type of pain. Exacerbations of somatic pain and
musculoskeletal pain responded to treatment more than dystonic and
dysesthetic pain.
Study leader Dr. C. R. Honey said that 15% to 46% of PD patients have
pain attributable to their disease.
Copyright 1999 Reuters Limited.
--
Judith Richards, London, Ontario, Canada
[log in to unmask]
^^^^
\ /
\ | / Today’s Research
\\ | // ...Tomorrow’s Cure
\ | /
\|/
`````
