[Perioperative management of a patient with Parkinson's disease with intravenous infusion of levodopa]

Abstract

Parkinson's disease is a disorder of the extrapyramidal system resulting from the deficiency of dopamine in the basal ganglia. We experienced the perioperative management of a patient with Parkinson's disease with intravenous infusion of levodopa, precursor of which is dopamine. A 73-year-old woman with Parkinson's tremor in her bilateral fingers of Hoehn and Yahr stage II was scheduled for repair of bladder prolapse under general anesthesia. Antiparkinson drug levodopa/dopa decarboxylase inhibitor (carbidopa) 400 mg per day had been administered orally to control her bilateral tremor. Three hours before the operation, oral medication including levodopa/carbidopa 100 mg was withdrawn, and intravenous infusion of levodopa 100mg was started. Without any premedication, anesthesia was induced with intravenous infusion of propofol, fentanyl, and vecuronium, and tracheal intubation was facilitated. Anesthesia was maintained with inhalation of air, oxygen, and sevoflurane, and intravenous infusion of fentanyl. After emergence, we found no neurological disorders excluding her tremor. Levodopa/carbidopa 100 mg was readministered orally four hours after the operation and total of 300 mg had been administered orally on the operative day. Levodopa/carbidopa 400 mg per day had been administered orally after the first operative day. She did not show deterioration of her symptom of Parkinson's disease, and develop any complications during the perioperative period. We need to manage Parkinson's disease with intravenous infusion of levodopa during the perioperative period, taking care of the symptom of Parkinson's disease and the occurrence of complications.