الفهرس 
Pathophysiology & management of ParkinsonismOnly 14 pages are availabe for public view
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Abstract
Parkinson’s disease is a disease of insidious onset usually in the second half of life , characterized clinically by slowly progressive akinesia, rigidity , postural abnormality and tremor.
The symptoms of Parkinson’s disease have now been established as due to decrease of dopamine in the caudate nucleus and putamen consequent to degeneration of substantia nigra.
Although there is no treatment that is known to reverse the neuronal degeneration that presumably underlies Parkinson’s disease , methods are now available which can bring about a considerable degree of relief from symptoms in many patients. These methods should be adapted to the patient’s needs , which vary with the stage of the disease and the predominant manifestations.
According to these methods the drugs used are : levodopa , anticholinergics , amantadine and bromocriptine. The optimal dose of these medications varies for each patient . The wide usage of these mdications provides a special challenge to the anaesthetist because the possibility of interactions of these medications with the drugs used in anaesthesia.
So knowledge of the pharmacologic action of the medications used for treatment of Parkinson’s disease is necessary to avoid the complications during anaesthesia.
Progress in the pharmacologic treatment of Parkinson’s disease has increased the possibity of patients with the disease developing conditions necessitating surgey . So careful preparation is necessary to ensure that these patients presented for surgery are in the best physical and mental conditions.
Anaesthesia should follow a balanced plan to face the multi-factorial problems imposed by these high risk group including :
1. Old age
2. The state of control their Parkinson’s disease.
3. The associated medical disorders.
4. The medications received and their adverse effects
Whenever possible , surgery should be carried out with local anaesthesia or regional blocks to avoid the general anaesthetic agents with their depressant or stimulant effect on the cardiovascular system.
For patients requiring general anaesthesia an anaesthetic plan is proposed including : a careful premedication , induction with intravenous anaesthetics and maintenance of anaesthesia which could be achieved by inhalational agents with increment doses of muscle relaxants.
Particular attention must be directed to the respiratory system after surgery . Muscle relaxants of the competitive type must be fully revesed to permit adequate function of the respiratory muscles.
Early alimentation and ambulation , always desirable in any surgical patient , are absolutely vital in the elderly patients with Parkinson’s disease.