Book contents
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Introduction
- Part 1 Perioperative Care of the Surgical Patient
- Section 1 General
- Section 2 Cardiology
- Section 3 Hypertension
- Section 4 Pulmonary
- Section 5 Gastroenterology
- Section 6 Hematology
- Section 7 Infectious disease
- Section 8 Renal disease
- Section 9 Endocrinology
- Section 10 Rheumatology
- Section 11 Neurology
- Chapter 35 Cerebrovascular disease
- Chapter 36 Management of the surgical patient with dementia
- Chapter 37 Neuromuscular disorders
- Chapter 38 Perioperative management of patients with Parkinson's disease
- Chapter 39 Delirium in the surgical patient
- Section 12 Surgery in the Elderly
- Section 13 Obesity
- Section 14 Transplantation
- Section 15 Psychiatric Disorders
- Section 16 Peripartum Patients
- Part 2 Surgical Procedures and their Complications
- Index
- References
Chapter 38 - Perioperative management of patients with Parkinson's disease
from Section 11 - Neurology
Published online by Cambridge University Press: 05 September 2013
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Introduction
- Part 1 Perioperative Care of the Surgical Patient
- Section 1 General
- Section 2 Cardiology
- Section 3 Hypertension
- Section 4 Pulmonary
- Section 5 Gastroenterology
- Section 6 Hematology
- Section 7 Infectious disease
- Section 8 Renal disease
- Section 9 Endocrinology
- Section 10 Rheumatology
- Section 11 Neurology
- Chapter 35 Cerebrovascular disease
- Chapter 36 Management of the surgical patient with dementia
- Chapter 37 Neuromuscular disorders
- Chapter 38 Perioperative management of patients with Parkinson's disease
- Chapter 39 Delirium in the surgical patient
- Section 12 Surgery in the Elderly
- Section 13 Obesity
- Section 14 Transplantation
- Section 15 Psychiatric Disorders
- Section 16 Peripartum Patients
- Part 2 Surgical Procedures and their Complications
- Index
- References
Summary
Introduction and overview of Parkinson's disease
Patients with Parkinson's disease (PD) face surgery more often than their age-matched counterparts due in large part to orthopedic and other injuries provoked by the gait and balance difficulties in advanced stages of the illness. General surgical procedures are at least as common in PD as in their age-matched counterparts, but the perioperative management can be complicated given the nature of the illness and its treatments. Recent advances in neurosurgical techniques and an improved understanding of the pathophysiology of motor symptoms in PD has led to a renewed interest and an increase in the number of patients undergoing various neurosurgical procedures for PD. This chapter provides an overview of the principles and preoperative management of patients with PD and other Parkinsonian states.
Parkinson's disease is an adult-onset neurodegenerative disorder characterized by progressive slowness of movement (bradykinesia), muscular rigidity, stooped posture, tremor, postural instability, and varying degrees of cognitive impairment. It affects close to 1 million Americans, with an annual incidence of 20 new cases per 10,000 and a prevalence of 59–187 cases per 100,000 [1–3]. The median age of onset is 60 years and the mean duration of the disease from diagnosis to death is 15 years [4]. Its pathology is concentrated in the brain and consists of selective degeneration of the nigrostriatal dopaminergic pathway and the presence of alpha synuclein pathology including Lewy bodies and Lewy neurites in surviving mesencephalic dopamine neurons, as well as in other brainstem and cortical neurons [5]. Biochemically, the denervation results in striatal dopamine depletion which is linked to the above signs and symptoms [6]. The cause of selective neuronal death, and therefore the etiology of PD is unknown, although hereditary and environmental factors are thought to play a role.
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- Chapter
- Information
- Medical Management of the Surgical PatientA Textbook of Perioperative Medicine, pp. 411 - 418Publisher: Cambridge University PressPrint publication year: 2013