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Iadt 07 I 5 P 427
Iadt 07 I 5 P 427
427
Indian Journal of Anaesthesia, October 2007
iopathic Parkinsons disease) may have a number of dif- be preferred. Treatment with and drug titration of LD
ferent causes such as arteriosclerosis, diffuse central for intravenous administration alone may be dangerous
nervous system degenerative disease, repeated head during general anaesthesia because of interactions with
trauma, tumor, metabolic defects such as Wilsons dis- anaesthetic agents. It may increase the risk of a variety
ease, heavy metal, or carbon monoxide poisoning. Drug- of arrhythmias or hypertension as reported previously.
induced Parkinsonism results from dopamine receptor These side effects of LD are mediated through its me-
blockade b y dr ugs su ch as ph en othiazin es, tabolite, dopamine.12
butyrophenones, and metoclopramide. In conclusion, we report the perioperative treat-
Particular anaesthetic problems are neurological, res- ment of a patient with Parkinsons disease by using ad-
piratory, and cardiovascular. The clinical features and the ministration of levodopa through a nasogastric tube dur-
interaction of common anaesthetics with the drug therapy ing propofol anaesthesia intraoperatively and in the early
of the patient present an anaesthetic challenge and di- postoperative period. The perioperative management
rectly influence perioperative morbidity and mortality. described in this report is practical, easy and prevented
L-dopa can only be administered enterally and its the exacerbation of Parkinsonian symptoms during the
half-life is short (13 h). It is absorbed from the proximal postoperative period. Though this patient underwent il-
small bowel and, therefore, cannot be given as a sup- eal surgery, absorption of levodopa from stomach and
pository.5 Ensure that patients do not miss medication duodenum was able to prevent any exacerbation of symp-
doses postoperatively. Regional anaesthesia has obvi- toms during intraoperative and postoperative period.
ous advantages over general anaesthesiaas it avoids the References
effects of general anaesthesia and neuromuscular block-
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sia is required, it is worth noting that L-dopa can be ad-
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patients receiving thiopental. 7,8 The clinical significance disease. Review Anaesthesist 2005 ;54:401-9; 410-1.
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disease because of an exaggerated sympathetic response. ease and anaesthesia Br J Anaesth 2002; 89: 904 - 916.
Propofol is an ideal agent to use because of its rapid 6. Furuya R, Hirai A, Andoh T, Kudoh I, Okumura F. Successful
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thesia. Anesthesiology 1998 ;89:261-3.
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patient with Parkinsons disease 9. There are numerous in Parkinsons disease resulting in postoperative respiratory
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The successful management of our case matches
12. Minsker DH, ScriabineA, Stokes AL:Effects of L-dopa alone and
few other case reports6. Enteral levodopa has a clear in combination with dopa decarboxylase inhibitors on the arterial
advantage over intravenous levodopa (LD) and should pressure and heart rate of dogs. Experientia 1971; 27:529-31.
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