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Perioperative Problems in Parkinson’s Disease and Their Management: Apomorphine with Rectal Domperidone

Published online by Cambridge University Press:  18 September 2015

Néstor Gálvez-Jimenez  and
Anthony E. Lang
Néstor Gálvez-Jimenez
Affiliation:
The Morton and Gloria Shulman Movement Disorders Centre, The Toronto Hospital, University of Toronto, Toronto
Anthony E. Lang*
Affiliation:
The Morton and Gloria Shulman Movement Disorders Centre, The Toronto Hospital, University of Toronto, Toronto
*
The Morton and Gloria Shulman Movement Disorders Centre, The Toronto Hospital, 399 Bathursl Street. MPI 1-306, Toronto, Ontario, Canada M5T 2S8
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Abstract

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Objective: To present guidelines on the use of apomorphine in combination with rectal domperidone in Parkinson’s disease (PD) patients undergoing abdominal surgery and to review the perioperative problems encountered in such patients. Background: PD patients undergoing abdominal surgery present a major therapeutic challenge. Because most antiparkinsonian medications must be withheld until the patient is able to resume oral intake, resulting rigidity and akinesia as well as alterations in gastrointestinal motility, respiratory function and swallowing mechanisms predispose these patients to numerous serious postoperative complications. We have found that parenteral apomorphine in combination with rectal domperidone markedly facilitates the care of these difficult patients. Methods: Presentation of two illustrative cases with review of the literature. Results: A standardized protocol using subcutaneous apomorphine and rectal domperidone was used in two PD patients who underwent abdominal surgery. Excellent control of parkinsonian symptomatology was obtained without side effects. The simplicity of the protocol was emphasized in our second patient who required urgent reoperation; the surgery nursing staff was able to restart the apomorphine immediately without having to wait for neurological follow-up assessment. Conclusions: The use of parenteral apomorphine with rectal domperidone in the immediate postoperative period for patients unable to take oral antiparkinson drugs increases patient comfort, facilitates nursing care and may reduce serious postoperative complications.

Résumé

Résumé

Difficultés périopérâtoires dans la maladie de Parkinson: utilisation de l’apomorphine et de la domperidone rectale. Objectif: Nous présentons des lignes de conduite sur l’utilisation de l’apomorphine combinée à la domperidone rectale chez les patients parkinsoniens qui subissent une chirurgie abdominale et nous revoyons les problèmes périopératiores rencontrés chez ces patients. Introduction: Les patients parkinsoniens qui subissent une chirurgie abdominale présentent un défi thérapeutique majeur. Comme la plupart des antiparkinsoniens doivent être cessés jusqu’à ce que le patient recommence l’alimentation orale, la rigidité, l’akinésie, les troubles du transit intestinal, de la fonction respiratoire et de la déglutition prédisposent ces patients à de nombreuses complications postopératoires. Nous avons constaté que l’administration d’apomorphine par voie paren-térale combinée à la domperidone par voie rectale facilite beaucoup le soin de ces patients. Méthodes: Nous présentons deux cas comme exemple ainsi qu’une revue de la littérature. Résultats: Nous avons utilisé un protocole standardisé pour l’administration sous-cutanée d’apomorphine et l’administration rectale de domperidone chez deux patients parkinsoniens qui ont subi une chirurgie abdominale. Un excellent contrôle des symptômes parkinsoniens a ainsi été obtenu, sans effet secondaire. La simplicité du protocole a été mise en évidence dans le second cas lorsque le patient a été soumis d’urgence à une nouvelle intervention chirurgicale. L’équipe de soins infirmiers chirurgicaux a pu réadministrer l’apomorphine immédiatement sans attendre une nouvelle évaluation neurologique. Conclusions: L’administration parentérale d’apomorphine combinée a la domperidone par voie rectale en postopératoire chez les patients chez qui on ne peut pas administrer la médication antiparkinsonienne par voie orale améliore le confort du patient, facilite les soins infirmiers et peut diminuer les complications postopératoires sérieuses.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 23 , Issue 3 , August 1996 , pp. 198 - 203
Copyright
Copyright © Canadian Neurological Sciences Federation 1996

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