Parkinson Secrets
Expert Tips and Interviews on Living with Parkinson's Disease
ParkinsonSecret_Header_01.jpg

Hot Topics in Parkinson’s Disease

Michael Okun Indu Subramanian Jonny Acheson

 

Anesthesia and management of Parkinson's before, during and after an operation

Publicly available image of a sample operating room at University of Florida Health

One of the most important topics in Parkinson’s management is understanding the person heading to the operating room— and being sensitive to the challenges they “will” face.

This week we will in the parkinsonsecrets.com blog review many of these issues in the context of:

Here are some tips we picked up from the Yim article, Cate Price’s PeCAN program and from the Aware in Care Parkinson’s Foundation kits from Parkinson’s Foundation hospitalization related projects.

  • “Patients with Parkinson’s disease are at higher risk of peri-operative medical and surgical complications.” Yim and colleagues…

  • “Multidisciplinary management, early recognition of potential complications, medications

    and intra-operative protection of the vulnerable brain” — all need special attention.

  • Groups who invest in a “peri-operative Parkinson’s disease pathway” have the potential for enhanced outcomes.

  • Telemedicine has been suggested as a strategy to augment peri-operative care.

  • Working with your DBS team if you are recieving Parkinson’s disease could be important in choosing the best anesthetic management during the procedure.

  • Propofol for example may rarely trigger dyskinesia or may affect microelectrode recording if having DBS.

  • Opioids rarely worsen muscle rigidity— this can contribute to dystonia.

  • Serotonin syndrome can occur when certain drugs are used with monoamine oxidase inhibitors, antidepressants and/or antipsychotics.

  • Monoamine oxidase inhibitors are usually stopped 1-2 weeks prior to an operation as some anesthetics and pain meds may interact.

  • Light sedation and local anaesthesia can be used during micro-electrode recording

    and macro-stimulation testing of the lead.

  • An ideal choice of sedative for DBS procedures would be one with the following properties: “minimal interference during micro-electrode recording and clinical testing; excellent titrate-ability; and low risk of adverse effects such as respiratory depression, bradycardia and hypotension.”

  • There is something called an enhanced recovery after surgery (ERAS) protocol. These plans can reduce hospitalization, morbidity, mortality and hospital costs.

  • “There is no peri-operative bundle of care specifically for patients with Parkinson’s disease, but certain aspects of existing ERAS programmes can be adapted.”

  • “Intra-operative anaesthetic management requires vigilance and prevention of hemodynamic, respiratory and neurological complications.”

  • Regional anesthetic techniques are recommended with possible.

  • Catherine Price PhD has a great program you can read about for screening pre-operatively to be proactive on potential cognitive issues. The program is called the Perioperative Cognitive Anesthetic Network program (PeCAN).

  • “PeCAN assesses how the brain interacts with surgery and anesthesia. This new program is the result of more than a decade of work aimed at understanding how a patient’s brain integrity prior to surgery could impact the recovery process, specifically with the goal of uncovering any increased risk for delirium, cognitive change and even mortality. We recognized that approximately a third of the individuals were having changes in their memory and thinking after having anesthesia and surgery,”

  • If your surgery requires general anaesthesia some groups use electroencephalographic signals to avoid giving too much anesthesia.

  • Some other tips from the Yim paper: “avoiding triggering medications (e.g. benzodiazepines); no urinary catheterization; ensuring good intra-operative analgesia; and providing a quiet and stress-free environment for recovery.”

  • There is something called opioid-sparing analgesia for folks who may be sensitive to opioid issues (constipation, sedation, respiratory depression.)

Below is a great summary from Yim et. al. on Parkinson’s motor issues and the anesthesia challenges.

The Parkinson’s Foundation in my opinion has the gold standard aware in care kits for Parkinson’s hospitalizations which includes surgical care. The kits are free and there is a free 18004PDINFO helpline with expert Parkinson nurses who can answer your questions. You can print 3 items:

  • Wallet Card

  • Nurse Fact Sheet Tear Off Pad

  • Medication Form

If you order the full kit is also has:

  • Hospital Action Plan

  • Kit bag, bracelet

  • Magnet

  • Specialty resources including the Duopa & Deep Brain Stimulation Information Cards

To read more books and articles by Michael S. Okun MD check on Twitter @MichaelOkun and these websites with blogs and information on his books and http://parkinsonsecrets.com/ #Livingwith Parkinson’s #EndingPD #Parkinsonsecrets #LessonsFromTheBedside

He also serves as the Medical Advisor for the Parkinson’s Foundation.

To see more on Dr. Indu Subramanian she does live interviews of experts in Parkinson’s for the PMD Alliance.

The blog artist is Jonny Acheson. 

Michael Okun