Parkinson Disease Case Study

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Anaesthetic Management of a patient with Parkinsonism Posted for Wide Excision of Skin Adenexal Tumour in the Axilla: A Case Report Introduction
Parkinsons disease has been known since biblical times but it was first formally described by James Parkinson in the 18th century and termed “the shaking palsy”. Although the aetiology of the disease is unknown, age has been identified as the most consistent risk factor. Parkinsons disease affects approximately 3% of the population over 66 years of age and with increasing age of the general surgical patients it is becoming an important cause of perioperative morbidity
Parkinsonism is due to the imbalance of the mutually antagonistic dopaminergic and cholinergic systems of the basal ganglia. Pigmented
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Volatile anesthetics can alter the dopaminergic balance in the brain, but whether they exacerbate PD is unknown. Propofol produces both dyskinesias and ablation of resting tremor, suggesting that it has both excitatory and inhibitory effects in this patient population. But both volatile agents as well as propofol has been successfully to sedate patients with PD during deep brain stimulation surgery. Dexmeditomidine appears to be safe and when used in deep brain stimulation surgery has advantage of not interfering with motor symptoms. Ketamine should be used with caution because of potential interaction between levodopa and ketamine’s sympathomimetic activity. Butryophenones( eg:-droperidol) and phenothiazines , which block dopamine receptors and exacerbate PD should be avoided. Ondansettron appears safe in preventing and treatment of emesis in patients with PD and is also used in treatment of psychosis induced by long term levodopa therapy. Opioids are more succeptible to produce muscle rigidity in patients with PD. Meperidine should be avoided in a patient taking monoamine oxidase inhibitor becaouse of the potential to produce stupor, rigidity, agitation and hyperthermia. Responses to depolarizing and nondepolarizing muscle relaxants are thought to be normal in PD, despite a single case report of succinylcholine induced
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