Katus and Shtilbans listed issues in the perioperative management of a patient with Parkinson’s disease. Proper management can avoid a number of complications. The authors are from New York Presbyterian Hospital, Weill Cornell Medical College and the Hospital for Special Surgery in New York City.


Patient selection: Parkinson’s disease


Potential complications in the perioperative period:

(1) aspiration pneumonia

(2) urinary tract infection

(3) worsening of Parkinson’s disease due to interruption of therapy

(4) falls

(5) contractures

(6) deconditioning

(7) pressure ulcers

(8) constipation

(9) adverse drug effects of anesthetic drugs, anti-emetics and analgesics

(10) agitation, hallucinations or cognitive impairment

(11) hypertension and/or hypotension

(12) damage to leads for a deep brain stimulator


All attempts should be made to keep the patient’s drug regimen as close to usual as possible. This may involve minimizing time spent NPO and finding alternative routes for drug administration.


Drugs to avoid or to be cautious with:

(1) halothane if the patient is taking levodopa

(2) opioid analgesics, especially fentanyl

(3) metoclopramide

(4) promethazine

(5) prochlorperazine

(6) benzodiazepines

(7) typical and some atypical antipsychotic agents (except quetiapine or clozapine)


MAO-B inhibitors should be discontinued 1-2 weeks prior to surgery if possible.


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