We present a case of severe rigidity during emergence from general anaesthesia in a 64-year-old man who had suffered from Parkinson's disease for nine years. Controversy still exists over how to optimally manage these patients perioperatively. We successfully managed his Parkinsonism with administration of crushed Sinemet® and amantadine via a nasogastric tube. This case report serves as a reminder of the importance that patients receive their anti-Parkinsonian medications perioperatively, and highlights the potential benefits of inserting a gastric tube to continue anti-Parkinson's medication dosing during prolonged surgery.
NicholsonG., PereiraA.C., HallG.M.Parkinson's disease and anaesthesia.Br J Anaesth2002; 89: 904–916.
2.
KalenkaA., HinkelbeinJ.Anaesthesia in patients with Parkinson's disease.Anaesthesist2005; 54: 401–409.
3.
BrownF., RedfernP.H.Studies into the mechanism of action of amantadine.Br J Pharmacol1976; 58: 561–567.
4.
GoyalN., WajifdarH., JainA.Anaesthetic management of a case of Parkinson's disease for emergency laparotomy using enteral levodopa intraoperatively.Ind J Anaesth2007; 51: 427–428.
5.
FugiiT., NahabayashiT., HashimotoS., KuwanoH.Successful perioperative management of patients with Parkinson's disease following gastrointestinal surgery: report of three cases.Surg Today2009; 39: 807–810.
6.
FuruyaR., HiraiA., AndohT., KudohI., OkumuraF.Successful perioperative management of a patient with Parkinson's disease by enteral levodopa administration under propofol anesthesia.Anesthesiology1998; 89: 261–263.
7.
KangW.J., OhJ.Y., KimK.S., KimD.O., KimD.S.An anesthetic management of a patient with Parkinson's disease who underwent Whipple's operation by enteral levodopa administration.Kor J Anesthesiol2002; 42: 125–128.
8.
KohliA., SwainA., SubbramaniamP.S., ThakurS., KhambraS., BhadoriaP.Parkinsonian crisis for emergency laparotomy: a case report.Internet J Anesth2009; 21: 1.
9.
PoeweW., WenningG.K.Apomorphine: an underutilized therapy for Parkinson's disease.Mov Disord2000; 15: 789–794.
