• Patients should have ALL their Parkinsonian medications at prescribed times at ALL times
• These patients are at high risk of developing complications post-operatively
• The elderly care and / or neurology team should be made aware early on of Parkinson’s patients coming for surgery and consulted if there are concerns or complications
• Lack of movement or talking and an expressionless face can result in misinterpretation of severity of pain and distress

This is a controlled document. If you are using a printed copy, check it against the version on the guidelines platform to ensure you are using the latest edition.

Abbreviations

1.1 To give guidance on the management of Parkinson’s patients in the peri-operative period

1.2 These guidelines are a general rule, principle or advice developed from evidence-based best practice, national recommendations tailored to specific local requirements and circumstances.

In individual cases deviation from these guidelines may be appropriate, but if this occurs it should be documented.

• Patients with Parkinson’s disease are at high risk of developing complications post-operatively. These include respiratory failure, delirium and slower rehabilitation

• A peri-operative (pre, intra and post-operative) plan should be in place BEFORE surgery and communicated to all relevant staff

Guidelines for Peri-operative Management of Parkinson’s patients

• POANs should alert the geriatric and / or neurological teams at the time of the POA of the date and type of surgery and details of current Parkinson’s treatment

• POANs should alert the anaesthetist

• Parkinson’s patient must always take all their Parkinson’s medications at the designated time regardless of fasting requirements – there is NO EXCEPTION

• If patients are unable to take their tablets (due to CNS or GIT dysfunction) alternative therapies (such as transdermal patches) need to be started under direction of the frailty team, geriatricians and / or neurologists

• Caution with prescribing medications – many drugs (especially CNS drugs) may interact with Parkinson’s drugs or worsen Parkinson’s symptoms

• All staff involved in care of Parkinson’s patients should be aware of specific problems they may have in the peri-operative period which may include

  • Bradykinesia and rigidity resulting respiratory failure, DVTs, pressure sores and slower recovery

  • Aspiration

  • Reduced ability to express emotions, pain or discomfort

  • Delirium, fatigue, depression and sleep disturbance

  • Instability and falls

  • Poor feeding – dysphagia and bradykinesia

  • Urinary retention

  • Hypotension and arrhythmias

  • Nausea and vomiting, constipation

Parkinson's disease: D J Chambers, BJA Education, Vol17: 4, April 2017, p 145–149

Perioperative Management of Patients with Parkinson's Disease 2014 , vol 127 :4,  p275-280

This guideline has been registered with the trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt contact a senior colleague or expert. Caution is advised when using guidelines after the review date. This guideline is for use in Frimley Health Trust hospitals only. Any use outside this location will not be supported by the Trust and will be at the risk of the individual using it.

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