UNDERGOING ANESTHESIA AND PARKINSON’S

When a Person With Parkinson’s (PWP) needs to undergo surgery, the use of general anesthesia should rigorously be discussed with your doctor, and the anesthesiologist because it can cause considerable consternation.  

     Generally, people who have had Parkinson’s for a long time, are on a variety of drugs which have potential interactions with anesthetic drugs. Additionally, and in most cases, the brains of  People with Parkinson’s are already fragile and uses of anesthesia have been reported to cause agitation, muscle rigidity, hyperthermia, and exaggerated cognitive instability including confusion, poor motor coordination, loss of short-term or long-term memory, identity confusion, and impaired judgment.

     PWPs on Carbidopa-Levodopa treatment will more than likely have severe nausea and vomiting along with associated depression and are more prone to be dehydrated and hypovolemic (a state of decreased blood volume). Adequate fluid management is very necessary in the periods before and after surgery.

     Anesthesia and Levodopa acting through a central mechanism contributes to a hypotensive (lowering of blood pressure) effect symptomized as anemia, constipation, dizziness, lightheadedness, or weakness when standing up suddenly or getting up in the morning, drowsiness, dry mouth, and fever.

     MAOI Inhibitors (Rasagiline (Azilect), Selegiline (Eldepryl, Zelapar), etc.) inhibit the metabolism of narcotics in the liver. Serotonin syndrome (autonomic instability with hypertension, tachycardia, hyperthermia, hyperreflexia, confusion, agitation, and diaphoresis) occurs when meperidine (Demerol) taken with Selegeline, resulting in agitation, muscle rigidity, and hyperthermia. Strongly consider NOT using this combination as the results can be fatal. Also, a person taking MAOI Inhibitors should be wearing a Medi-Alert identifying these allergies or contraindications.

TO REPEAT, ANESTHETIC IMPLICATIONS

Autonomic dysfunction can produce diverse symptoms, such as orthostatic hypotension, sialorrhea, constipation, incontinence, and frequency, excessive sweating, and seborrhea. Autonomic instability can lead to a sudden, exaggerated or uncertain response anesthesia.

Respiratory dysfunction results from the uncoordinated involuntary movement as a result of rigidity and muscle weakness. Also, pharyngeal muscle weakness (the membrane-lined cavity behind the nose and mouth, connecting them to the esophagus) leads to increased retention and improper impaired expulsion of respiratory secretions and can cause perioperative aspiration pneumonia.

Gastrointestinal symptoms include loss of appetite as a result of age, depression, or medications-induced nausea and vomiting, which lead to loss of weight. These people can become predisposed to gastroesophageal reflux.

Neuropsychiatric symptoms include changes in mood (depression), cognition and behavior. Psychotic symptoms include delusions and hallucinations. These symptoms can lead to postoperative emergence reactions and with associated tremors and rigidity can lead to difficult situations and problems.