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Parkinson's Disease
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Assess severity of any upper airway dysfunction (dysphagia, excess salivation, history of aspiration) to determine risk of aspiration

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May 18, 2011
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Adequate hydration perioperatively will reduce the risk of orthostatic hypotension

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Sep 22, 2012
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Put the patient first on the theatre list (as the timing of drug administration is predictable, and also to reduce the chances of the patient being cancelled. If the patient is cancelled then medication should be recommenced)
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Sep 22, 2012
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Nausea/vomiting can hinder restarting enteral parkinson's disease drugs, so where appropriate use a technique that minimises this, and administer safe anti-emetics.

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Sep 23, 2012
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The anti emetic of choice is domperidone (10- 20 mg 4-6 hourly PO, or 30-60 mg 4-6 hourly PR). Domperidone does not cross the BBB (blood brain barrier) and thus does not cause extra pyramidal effects.
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Sep 23, 2012
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difficult laryngoscopy may occur due to flexion deformity of the neck.

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Sep 22, 2012
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A non-centrally acting antisialogogue such as glycopyrrulate may help reduce excessive airway secretions.

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Sep 23, 2012
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Autonomic neuropathy may lead to delayed gastric emptying and an increased risk of pulmonary aspiration at induction. If general anaesthesia is required, consider an anaesthetic technique that protects the airway from aspiration.

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Sep 20, 2012
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May have autonomic dysfunction and impaired response to hypotension from anaesthesia/IPPV/postural change.

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May 18, 2011
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Postural hypotension may indicate autonomic dysfunction and risk of drug-induced hypotension

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May 18, 2011
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Domperidone and ondasetron are safe antiemetics

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Sep 23, 2012
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Pethidine should be avoided as this can cause
hypertension and muscle rigidity in patients on selegiline
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Sep 22, 2012
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Avoid metoclopramide, phenothiazine, butyrophenone as they may exacerbate the patient's extra-pyramidal symptoms.

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Sep 22, 2012
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Consider avoiding centrally acting anticholinergics (eg atropine) can precipitate central anticholinergic syndrome. Glycopyrrolate is the anticholinergic of choice.
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Sep 23, 2012
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Have vasopressors drawn up prior to induction to counter blood pressure changes seen with autonomic dysfunction.

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Nov 30, 2011
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Patients taking bromocriptine or pergolide are prone to excessive vasodilation.

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May 18, 2011
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At risk of post operative confusion/delirium. #ref

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Aug 31, 2012
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