BRAIN and NERVE Shinkei Kenkyu no Shinpo Volume 67, Issue 2 (February 2015)

Perioperative Management of Parkinson's Disease Takayoshi Shimohata 1 , Keiko Shimohata 2 , Masatoyo Nishizawa 1 1Department of Neurology, Brain Research Institute, Niigata University 2Department of Anesthesiology, Kameda Daiichi Hospital Keyword: パーキンソン病 , 外科手術 , 麻酔 , 抗パーキンソン病薬 , Parkinsonism-hyperpyrexia症候群 , Parkinson's disease , surgery , anesthesia , anti-Parkinsonian drug , Parkinsonism-hyperpyrexia syndrome pp.205-211
Published Date 2015/2/1
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Several studies have demonstrated the serious impact of surgeries on patients with Parkinson's disease (PD). In addition, PD is a risk factor for postoperative complications and prolonged hospital stays. Discontinuation of anti-Parkinsonian drugs due to surgery causes an exacerbation of Parkinsonism and sometimes Parkinsonism-hyperpyrexia syndrome (PHS). Therefore, surgeries involving patients with PD require careful perioperative management. During the preoperative period, cooperation among neurologists, surgeons, and anesthesiologists is imperative. Administration of the same oral anti-Parkinsonian drug regimen that was prescribed during home care is important. Methods of both general and regional anesthesia should be chosen based on general health status and symptoms of Parkinsonism and agents should be selected with due consideration of their possible interaction with anti-Parkinsonian drugs. In patients with PD showing autonomic disturbance, changes in blood pressure and body temperature should be monitored. During the postoperative phase, postoperative pain, aspiration pneumonia, ileus, and psychotic symptoms should be managed, taking into consideration the interactions between anti-Parkinsonian drugs and therapeutic agents. Currently, new anti-Parkinsonian drugs, such as rotigotine and apomorphine are available for patients with PD requiring parenteral treatment. It is important that medical experts share awareness about perioperative problems and their management in patients with PD.

(Received July 3, 2014; Accepted October 29, 2014: Published February 1, 2015)

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BRAIN and NERVE-神経研究の進歩
67巻2号 (2015年2月)
電子版ISSN 1344-8129 印刷版ISSN 1881-6096 医学書院