Parkinson’s disease is a neurological disorder in the elderly that is caused by changes in the normal parts of the brain.
Parkinson’s disease can have a significant effect on the anesthesia and management of Parkinson’s patients.
It is the second most degenerative neurological disorder in the elderly after Alzheimer’s disease.
In Parkinson’s disease, parts of the brain cannot produce and secrete a specific substance called dopamine.
What are the symptoms in people with Parkinson’s disease?
One and a half percent of people over the age of sixty-five worldwide have the disorder, and symptoms in people with Parkinson’s disease include:
- Resting tremer: Tremors in the hands and legs at rest
- Slow motion
- Stiffness and dryness of the neck, arms and legs (rigidity)
- Impaired balance
Little by little symptoms like:
- Decreased ability to perform unconscious movements such as smiling or blinking
- Masked face
- Difficulty and dysfunction in writing
- Speech problems
It also adds to the clinical manifestations of the affected person.
What causes Parkinson’s disease?
- Brain injuries
- Carbon monoxide poisoning
- Brain infections
- And drugs such as phenothiazine
Can lead to Parkinson’s disease.
Risks of anesthesia and surgery in patients with Parkinson’s disease
According to doctors, people with PD are more likely to have problems with their respiratory and cardiovascular systems.
Problems with the following systems are more common in people with PD:
All of these problems can make it difficult and different for people with Parkinson’s to tolerate anesthesia and surgical complications.
- Problems with the respiratory system:
Obstructive respiratory dysfunction is seen in people with Parkinson’s.
Decreased ventilator function increases their mortality.
In other words, reduced ventilation and lung cleansing put these people at risk for sometimes fatal lung infections.
One of the major problems in people with Parkinson’s during anesthesia is that they are more likely to have aspiration and therefore to have pneumonia following aspiration.
Also, the muscles of the respiratory tract in this group of people are very prone to collapse and sleeping on top of each other, Laryngospasm is common in this group.
- Cardiovascular system:
Orthostatic hypotension or OH is one of the problems that people with PD face.
Medications used in these people can have a significant effect on ventricular activity.
Therefore, the type of drugs, their dose in anesthesia for people with Parkinson’s should be carefully selected.
Most types of surgery in people with Parkinson’s are related to the following fields:
- Accidents and traumas
The following pharmacological considerations are very important:
- Antiemetic drugs:
Drugs such as phenothiazine, butyrophenone, and haloperidol are contraindicated in these people and may aggravate their symptoms and may also increase the risk of ventricular arrhythmias in these people.
So ondansetron and antihistamines are safe to control nausea and vomiting in these people.
It is better to use NSAIDs instead of opioids in these people.
- Before surgery:
Assess respiratory status
Cardiovascular status assessment
Electrocardiogram and simple chest x-ray, Perform spirometry, echocardiography, complete blood and arterial blood gas tests.
Evaluation of problems related to cardiac arrhythmia, blood pressure, etc.
- During surgery:
To control Muscle rigidity, medications for a person with Parkinson’s should be delivered through a gastric tube so that they do not have respiratory problems.
- After surgery:
Nsaids should be used instead of narcotic analgesics.