Upper airway involvement in Parkinson’s disease resulting in postoperative respiratory failure

Abstract

Parkinson's disease (PD) is a disorder of the extrapyramidal system resulting from the deficiency of dopamine in the basal ganglia. ~ It is characterized by bradykinesia, rigidity, rest tremour, and parasympathetic hyperactivity. Respiratory dysfunction has been noted in patients with PD and multiple causes have been proposed including impaired central control of respiration, abnormal extrapyramidal control of respiratory muscles, excessive secretions, decreased chest wall compliance, and upper airway obstruction. [2][3][4] This report describes a patient who developed respiratory failure two days after an anterior resection of the rectum for carcinoma. Upper airway dysfunction with obstruction was considered to have had a contributory role in causing the respiratory failure. Case reportA 71-yr-old man with a history of Parkinson's disease, Type II diabetes mellitus, myocardial infarction, and remote 20 pack-year smoking history, presented for resection of rectal carcinoma. He had undergone a remote cholecystectomy without event. His medications on admission were levodopa-carbidopa 100/25 mg rid, selegiline chlorhydrate 5 mg bid, chlorpropamide 100 mg daily, nifedipine 10 mg bid, propanolol 10 mg bid and enteric coated acetylsalicylic acid 325 mg daily. At the preoperative visit, one day before surgery, he had no complaints of dyspnoea or shortness of breath. He exercised daily on a stationary bicycle without angina. Examination of the heart and chest were unremarkable. Neurological as- CAN J ANAESTH 1995 / 42:4 / pp344-7

Parkinson’s disease influences the perioperative risk profile in surgery

“…Although the rate of pneumonia was not significantly different in our patient cohort when compared to controls, it is possible that the treating physicians realized the importance of interventions, ranging from forced respiratory therapy, continuous positive airway pressure training, and frequent X-ray control of the thorax, and instituted these preventive measures. Easdown et al reported that sufficient and prompt intake of Parkinson medication positively affects not only the symptoms of PD but also improves inspiration and expiration in particular, thereby possibly decreasing the incidence of pulmonary infection [10].…”

“…Additionally, lethargy, rigidity, and a possible lack of coordinated control of thoracic musculature may be present [2,3]. Consequently, aspiration pneumonia is one of the most common causes of death in patients with PD [10]. Although the rate of pneumonia was not significantly different in our patient cohort when compared to controls, it is possible that the treating physicians realized the importance of interventions, ranging from forced respiratory therapy, continuous positive airway pressure training, and frequent X-ray control of the thorax, and instituted these preventive measures.…”

Modeling of the Sedative and Airway Obstruction Effects of Propofol in Patients with Parkinson Disease undergoing Stereotactic Surgery

“…1 The anatomic alteration is located in the neurons of the extrapyramidal system, and the main clinical manifestations are rigidity and tremor. 2 Besides these neurologic alterations, respiratory dysfunction has been described in these patients due to involuntary movements of the glottis and supraglottic structures. 3 Patients with PD resistant to pharmacologic treatment may have the opportunity to undergo a therapeutic surgical procedure in an advanced stage of their illness.…”

Anaesthetic Management of a Geriatric Patient with Parkinson’s Disease, who was Posted for Emergency Laparotomy- A Case Report

“…Upper airway dysfunction can cause retained secretions, atelectasis, aspiration, lower respiratory tract infections and post extubation laryngospasms [6]. The Parkinsonism-Hyperpyrexia Syndrome (PHS) can occur in the perioperative period.…”