Does Anesthesia Affect Parkinson’s Disease

Effect Of Sevoflurane On Neuronal Oscillation In The Subthalamic Nucleus

Although the fundamental spiking properties of the subthalamic neurons were similar under sevoflurane and local anesthesia, sevoflurane induced a shift in the oscillatory entrainment toward subbeta bands. Under general anesthesia, subthalamic nucleus spiking demonstrated increased power in the delta, theta, and alpha range, and decreased power in the beta range. Despite distinct molecular targets, sevoflurane was shown to induce unconsciousness in a manner similar to propofol and ketamine by interfering with coherent oscillations between cortical layers of frontal and parietal lobes.,  These effects on the group oscillations of subthalamic neurons further confirm that sevoflurane has a similar influence on basal gangliarelated oscillatory dynamics and anesthesia as propofol. In contrast, Velly et al. suggested that sevoflurane and propofol produce unconsciousness and analgesia through distinct effects on cortical and subcortical structures.  A recent study using desflurane during microelectrode recording of deep brain stimulation surgery showed enhanced power over theta band range oscillation only, which further indicates that different volatile anesthetics work through different mechanisms on drug-induced unconsciousness and analgesia., 

General Anesthesia And Parkinsons Disease

C.-W. CHEN, K.-B. CHEN, Y.-C. KUO

Session Time: 1:45pm-3:15pm

Location: Exhibit Hall C

Objective: Postoperative cognitive dysfunction is common among the elderly. These changes may even be so severe that some elderly people actually become demented after undergoing an operation. There was minimal evidence to support continued postoperative cognitive decline beyond 5 years or more. The aim of this study is to explore whether general anesthesia impact the incidence of Parkinsons disease in nationwide population.

Background: Parkinsons disease is one of the important diseases among older population and leads to disability. The exact mechanism of PD is variant. Whether general anesthesia is a potential risk factor for the development of PD is controversial. Therefore, this study aimed to evaluate the association between previous exposure to different types of GA and the incidence of PD.

Methods: Using claims data of 1,000,000 insured residents covered in the national health insurance, we enrolled 4,931 newly diagnosed dementia cases with age more than 50 years-old in 2005-2009. The control group of 19,720 individuals without PD was matched for age, gender, and index date. GA were categorized as three subtypes, including endotracheal tube intubation general anesthesia , intravenous injection general anesthesia or intramuscular injection general anesthesia , and heavy sedation. Multivariate logistic regression model was used for analyses.

To cite this abstract in AMA style:

Preoperative Use Of Levodopa

Patients with advanced Parkinson’s disease are at risk for exacerbations in the perioperative period. The timing of doses of Parkinson’s medication is very important, as abrupt withdrawal of drugs can often cause a very sudden return or even worsening of symptoms and in some cases can lead to the development of a condition known as neuroleptic malignant syndrome, which can be very dangerous. The half-life of levodopa is 13 h and so interruption should be as brief as possible, and therapeutic administration should be continued through the morning of surgery with sips of water. As it is absorbed from the proximal small bowel and thus has to first traverse the stomach making administration of tablets through gastric tube suboptimal or ineffective, because patients with Parkinson’s often have delayed gastric emptying. As such a duodenal feeding tube may be necessary when a prolonged period of normal feeding is expected. Patients may self-administer additional levodopa, so it is important to find out exactly how much they are taking.

Enteral levodopa has a clear advantage over intravenous levodopa and should be preferred. Treatment with and drug titration of levodopa for intravenous administration alone may be dangerous during general anesthesia because of interactions with anesthetic agents. It may increase the risk of a variety of arrhythmias or hypertension. These side effects of levodopa are mediated through its metabolite, dopamine.

Maintaining Your Normal Pd Medication Schedule

Maintaining your PD medication schedule is crucial for anyone with PD. The correct timing and dosage are essential to your comfort and well-being. However, oftentimes when undergoing surgery, there may be restrictions regarding when you can and cannot take medications. Here are a few tips to navigate this issue:

Other Concerns To Be Aware Of

There are a few other possible concerns to be aware of when having surgery. Again, not everyone will experience these issues, but it is wise to understand them and be aware so that you can plan accordingly and be prepared.

• The effect of even mild dehydration may be exacerbated in PD.
• People with PD may have swallow dysfunction. This can be exacerbated by anesthesia and make people with PD at higher risk for aspiration, defined as the tendency for food or liquid to get into the airway. Therefore, it is best to introduce soft foods slowly after surgery.

• People with PD may have significant fluctuations of blood pressure which can be magnified in the post-operative period. Episodes of low blood pressure can cause dizziness and even fainting. This problem is most prominent when changing head position that is moving from lying down, to sitting to standing. Therefore, these changes should be made very slowly.

• Urinary dysfunction is common in PD, and people with PD may be particularly prone to urinary tract infections . It is important to note that UTIs or any infection may first manifest as an unexplained worsening of PD symptoms or initiation of hallucinations.
• People with PD are particularly prone to constipation and this can be exacerbated in the post-operative period. Taking a daily medication to prevent constipation may become necessary after surgery.

Tips and takeaways

Do you have a question or issue that you would like Dr. Gilbert to explore?

Dr. Rebecca Gilbert

Being Prepared & Anticipating Problems

Because of the concerns that we will discuss below, it is prudent to have your neurologist speak to your surgeon and anesthesiologist prior to the surgery so he/she can discuss the potential issues that may arise during and after the surgery. It is also very useful to have your neurologist write a letter with all the necessary information so it can be dispersed to other members of the medical team who will be responsible for your day-to-day care after the surgery.

Depending on the type of surgery, there may be more than one option for anesthesia. General anesthesia may not be the only option, and a more localized form of anesthesia may be possible. Local anesthesia typically causes fewer side effects. Discuss what anesthesia options you have with the surgeon and anesthesiologist prior to the surgery.

In addition, if the surgery requires you to stay in the hospital overnight, consider having a family member or friend stay with you. This person can provide a calming presence, helping to prevent agitation or distress. He or she can keep an eye on whether you are taking your own medications correctly and what additional medications you are bring given.

Thankfully None Of This Is Going To Happen

Which is what I want to tell you about now. So let me start by reassuring you of this:

I feel fine. Absolutely fine.

In some ways, Im happier and more positive than I was before I got that initial shocking diagnosis.

My hands no longer shake. I sleep like a lamb. And I recall all the important details about my life or what I did this morning! with ease.

Second, theres a reason I feel this way. And its to do with how Ive actively worked on my condition.

And Now I Know Why We Dont

There are 8 main factors leading to Parkinsons. Some have a small effect. A couple are huge.

Together theyre essential in beating this horrible condition.

In truth, some of them my health-care center already acted on.

For example, they prescribed dopamine-enhancing drugs. For sure, I needed more dopamine.

I had tests and underwent occupational therapy. Again, good stuff it helped me manage my problems with balance, movement, stiffness.

But I also realized they were not helping me to avoid the worst symptoms of this disease. At best, they were just delaying it.

Yet thats what I wanted most to not end up with my own personal Parkinsons horror story.

Which is why I went headlong into my own research about my illness and, eventually, found my way out.

We Have Choices About How This Condition Plays Out

In fact, medical scientists have proved that many people with a genetic disposition to this never get it.

While others with no genetic disposition at all still get full-on Parkinsons that ravages their mental health quickly and remorselessly.

Its not genetics. Its a basic illness with recognized causes.

Remember: the substantia nigra produces dopamine. Its the loss of substantia nigra nerve cells that leads to the loss of dopamine.

And that loss of dopamine leads to Parkinsons Disease.

So the big question is:

Why on earth is the substantia nigra losing those dopamine-producing cells in the first place?

I was shocked to discover that we already know why were losing those priceless, life-giving substantia nigra cells.

Yet still do almost nothing about it

Sedation And Regional Anesthesia For Deep Brain Stimulation In Parkinsons Disease

Dilek Yazicioglu

1Ankara Diskapi Yildirim Beyazit Teaching and Research Hospital, Irfan Bastug Caddesi, Dskap, 06330 Ankara, Turkey

Academic Editor:

Abstract

Objective. To present the conscious sedation and the regional anesthesia technique, consisting of scalp block and superficial cervical plexus block, used in our institution for patients undergoing deep brain stimulation for the treatment of Parkinsons disease . Methods. The study included 26 consecutive patients. A standardized anesthesia protocol was used and clinical data were collected prospectively. Results. Conscious sedation and regional anesthesia were used in all cases. The dexmedetomidine loading dose was 1gkg1 and mean infusion rate was 0.26gkg1h1 . Propofol was used to facilitate regional anesthesia. Mean propofol dose was 1.68mgkg . Scalp block and superficial cervical plexus block were used for regional anesthesia. Anesthesia related complications were minor. Postoperative pain was evaluated; mean visual analog scale pain scores were 0 at the postoperative 1st and 6th hours and 4 at the 12th and 24th hours. Values are mean . . Dexmedetomidine sedation along with scalp block and SCPB provides good surgical conditions and pain relief and does not interfere with neurophysiologic testing during DBS for PD. During DBS the SCPB may be beneficial for patients with osteoarthritic cervical pain. This trial is registered with Clinical Trials Identifier .

1. Introduction

2. Methods

3. Results

A Pragmatic Approach To The Perioperative Management Of Parkinsons Disease

Department of Neurology, Georgetown University Hospital, Washington, DC, USA

Shivam Om Mittal

Department of Neurology, Cleveland Clinic, Abu Dhabi, United Arab Emirates

Guillaume Lamotte

Department of Neurology, Mayo Clinic, Rochester, MN, USA

Fernando Luis Pagan

Department of Neurology, Georgetown University Hospital, Washington, DC, USA

Corresponding

Rights & Permissions

Disadvantages Of Regional Anesthesia Over General Anesthesia

Anesthetic Management For Steriotactic Pallidotomy/thalamotomy

Classically local anesthesia with minimal or no sedation has been used for patients undergoing stereotactic procedures. This allows for patient participation in target localization and immediate observation of effects of test and lesion. Antiparkinsonian mediations are withheld for 1224 h prior to surgery. Therapy for concurrent diseases must be continued till the day of surgery.

Under LA, in magnetic resonance imaging suite stereotactic frame applied. Extra padding and rolls can make the patient more comfortable. Also these patients are very motivated to co-operate, unless there is dementia present. LA again is used to do burr hole and if the patient becomes agitated, midazolam can be titrated to desired effect. It is important that level of sedation does not impair co-operation or interfere with communication between surgeon and patient. Age, varying levels of dementia, fatigue, and cumulative effects of medication make it necessary to titrate the drugs slowly. Since propofol may elicit abnormal movements and may at times improve parkinsonian tremor, it might not be ideally suited for patients with movement disorders undergoing functional stereotactic neurosurgery.

Parkinsons Disease And Preparing For Surgery

People with Parkinsons disease sometimes face procedures or surgeries due to other medical conditions not related to PD. These could be relatively simple procedures such as a colonoscopy or endoscopy, common surgeries such as cataract removal, gall bladder removal or hernia repair, or more complex surgeries such as open-heart surgery or transplant surgery. I am frequently asked about specific concerns that arise when contemplating surgery for someone with PD.

People with PD, as well as people with other brain disorders, are more prone to side effects from anesthesia as well as negative effects from the stress of the surgery itself. Its important to remember that not everyone is affected in the same way, and this doesnt mean people with PD cannot have the surgeries and procedures they need. It is however important to be educated about what potential problems may arise so that you are as prepared as you can be.

Factors That May Make Your Symptoms Worse:

• Failure to get medications at specific times and coordinated with meals.
• Certain dopamine blocking drugs can worsen symptoms. If absolutely necessary because of hallucinations or behavior, only quetiapine or clozapine should be used.
• Anxiety, stress, and sleep deprivation
• Urinary tract, lung, or other infections
• Provide Advance Directives: Power of attorney for health care and living will. Choose an advocate who can ask questions and act as your spokesperson. Make sure this person is aware of your medical wishes so he or she can assist in speaking for you if needed.

I Feel Wonderful And Theres A Reason Why

Actually, there are three fantastic reasons:

First and foremost: I have tackled the loss of dopamine by working on the underlying cause of that loss.

We know that cell loss in the substantia nigra is the direct cause of dopamine loss. I address that cell loss in gentle but powerful ways and so protect dopamine levels.

Second, I increase dopamine production in my brain using non-drug methods. Increasing dopamine fights this condition head-on leading to wonderfully quick improvements.

Third, I have taken each of the symptoms of my illness stiffness, shaking, anxiety and so on and addressed them directly. Ive enacted specific daily habits that make those symptoms reduce to almost nothing.

How I Treated My Own Brain Deterioration

Everything I did to restore my own brain health I learned from a natural health practitioner called Jodi Knapp.

I discovered Jodi on a local health forum some years ago. She works with people using natural approaches to reverse illnesses which were caused by natural causes.

Which is, in fact, almost every illness known to man.

Her philosophy is simple: disease always has a cause.

If I have pain, a deterioration or some painful or deadly affliction there are reasons why I have it.

It doesnt just happen.

Understand those reasons and we have ways of reversing whats gone wrong.

Jodis incredible success rate at treating allegedly untreatable illness comes from her starting at the illnesses first causes.

Those causes are always natural causes. She tackles them and changes lives.

Five Frequently Asked Questions About Hospitalization For Patients With Parkinson’s Disease

Most people with Parkinson’s disease will need to be hospitalized at some time. Hospitalization can be stressful for various reasons. The neurologist who takes care of you and manages your Parkinson’s disease medications may not have privileges at the hospital where you are admitted. The hospital physicians and nursing staff may not know a lot about PD. If you undergo surgery or other invasive medical procedures, you may not be able to take any medications until the surgery or procedure is complete.

It is important for the patient and the caregiver to plan and anticipate what is likely to happen. This article will answer five of the most frequently asked questions about hospitalization for people with Parkinson’s disease.

Offline Analysis Of Subthalamic Nucleus Spike Firing

Raw spike recordings from the implanted trajectories were analyzed using custom-written scripts in MATLAB R2014b . Raw recordings were visually inspected by a neurophysiologist blind to patient anesthesia group to exclude artifacts . Background spiking activity was estimated using the normalized root mean square of each subthalamic nucleus recording.  The root mean square value of each recording was also normalized by the root mean square value of the baseline presubthalamic nucleus recording of each tract to control for factors such as electrode impedance and electrical noise that vary between subjects.

Single-neuron spike detection was performed using the voltage threshold method. Putative single neurons were identified offline using principal component analysis and the presence of a central trough in the autocorrelogram . Isolation of the spike train was graded by evaluating the fraction of spikes within the refractory period of 1.5 ms out of the total number of spikes in the spike train, and only spike trains with a fraction of less than 1% were processed. Spikes degraded by obvious cardiobalistic or other artefacts were excluded.

I Had Deep Brain Stimulators Placed Two Years Ago I Now Need To Have Knee Replacement Surgery Will The Doctors Know How To Take Care Of Me

Many medical professionals and hospitals still may not be familiar with this treatment. There are a few things you and your doctors should be aware of. First, if you have had DBS surgery, you can only get a MRI of the brain, and it must be done with something called a head-receive coil. You cannot get a MRI of any other part of the body, because the DBS device can become heated and damage the brain tissue during MRI. Radiologists performing a brain MRI can learn of certain precautions from the FDA. Additionally, your stimulator’s voltage should be turned down to 0 before the MRI. Only a programmer experienced with MRI should supervise the procedure.

An electrocardiogram may be important if you happen to have cardiac problems before, during or after surgery. But the stimulators may interfere with the EKG. Bring your portable Medtronic Access Device or Access Review Device to turn off your stimulator in the hospital. Know how to turn your stimulators on and off before going to the hospital, or having any type of surgery. Similarly, if you need a brain wave test – an electroencephalogram – or will simply be monitored during an inpatient or outpatient procedure, know how to turn that device off.

Parkinsonian Symptoms During Emergence From General Anesthesia

Professor of Anesthesia.

Associate Professor of Anesthesia.

Received from the Department of Anesthesia, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. Submitted for publication June 14, 1994. Accepted for publication September 14, 1994.

Address reprint requests to Dr. Muravchick: Department of Anesthesia, Courtyard 402, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pennsylvania 191044283.

Anesthesiology

Stanley Muravchick, DavidS. Smith; Parkinsonian Symptoms during Emergence from General Anesthesia. Anesthesiology 1995; 82:305307 doi:

Key words: Anesthetics, volatile: isoflurane. Disease: Parkinson’s disease. Postoperative complications: akinesis; delayed extubation; rigidity.

THE fundamental neurochemical lesion that causes idiopathic or primary Parkinson’s disease is well established, but the anesthetic implications of dopaminergic deficiency within the basal ganglia remain unknown. The literature relevant to anesthetic practice simply cautions against the perioperative use of adjuvant drugs that are thought to have dopaminergic blocking or cholinomimetic properties. It remains unclear whether general anesthesia is associated with significant changes in dopaminergic activity. We present a report of severe and prolonged dystonic muscle rigidity during emergence from otherwise routine general anesthesia in a patient who was subsequently found to have classic Parkinson’s disease.

Im Not A Medical Rebel

Now I should point out here that I am not the kind of person who second-guesses his doctor!

I trust professionals and experts. They studied for years. They do the research. They know plenty.

But their most effective meds came with unpleasant side-effects.

And those meds would become less effective as time wore on.

They would work for a while and then theyd start failing.

And as they failed my health would fail even more.

What kind of future is that?

Why Does Modern Medicine Know This But Ignore It

Why dont we tackle the inflammation and toxins causes of those nerve cells continually dying in the substantia nigra?

My doctor told me: its cultural.

Most patients especially in western countries want a drug or a procedure for a problem.

Something thats a one-off fix like an operation.

Or an easy, regular thing like a course of tablets.

What they dont want to have to make an effort to heal themselves. So pills it is.

But most inflammatory diseases can be tackled more effectively by lifestyle changes than by drugs.

Whole classes of deadly modern illnesses can be changed by a small number of simple, targeted lifestyle tweaks.

But our medics push meds because they know that, mostly, their patients wont make lifestyle changes.

So they give their patients drugs knowing that theyll at least take them.

Frustratingly, the best solution addressing lifestyle factors isnt at all difficult. Its just that popping a pill is easier.

Information Checklist For Your Nurse And Doctor When You Enter The Hospital

• Name of your Parkinson’s disease neurologist.
• Phone Number of your PD neurologist.

The following are some suggestions to make the hospitalization of this person with PD smoother:

• Parkinson’s disease medications often need to be given at specific times of the day. When writing medications in the orders, please use specific times .
• Patients with PD should resume medications immediately following procedures, unless vomiting or severely incapacitated.
• If there is confusion, consider urinary or lung infections.  Also, pain medications or benzodiazepines may be potential causes.

Microelectrode Recording Procedure And Localization Of The Stimulation Electrode

The microelectrode was 10 to 40 m in diameter and 200 mm in length, with a less than 50 m tungsten tip and recording impedance between 0.5 and 1 M. The microelectrode signal was recorded using an intraoperative microelectrode recording system . The raw signals were amplified and band-pass filtered . Recording started 10 mm above the planned target coordinates, and the microelectrode was advanced in steps of 200 to 500 µm with pauses at sites of robust neuronal firing. The discharge from each depth was recorded for at least 10 s.

Anesthetic Drugs May Interact With Medications Used For Parkinsons Disease

Lorri A. Lee, MD; Tricia A. Meyer, PharmD, MS, FASHP

An estimated one million people in the United States have been diagnosed with Parkinsons Disease making it one of the most common neurological disorders in patients. This number is estimated to double in the next 30 years as PD is associated with increasing age. PD patients have a deficiency of dopamine in their brain and many of their medications are used to increase this neurotransmitter. They are frequently very sensitive to missing even one dose of their Parkinson medications and may exhibit increased rigidity, loss of balance, agitation, and confusion if their dosing schedule is delayed. Neuroleptic malignant syndrome or parkinsonism-hyperpyrexia syndrome can develop if their medications are held too long or as a result of serious infection.1 Many drugs used in the perioperative period, such as metoclopramide, butyrophenones , and phenothiazines have anti-dopaminergic activity that can worsen the symptoms of PD.

PD patients may be prescribed selective MAOI-B medications such as selegiline and rasagiline that inhibit metabolism of dopamine. Though caution is still advised, several studies have demonstrated that the risk of serotonin syndrome with these selective MAOI-B drugs is extremely low, even in combination with serotonergic antidepressants.

The authors have no conflicts of interest to declare for this article.

Advantages Of Regional Anesthesia Over General Anesthesia