Parkinsonism and the anaesthetist

There are similarities between the motor disorder of Parkinsonism, the rigidity associated with the use of opioid drugs and the phenomenon of shaking during recovery from anaesthesia. Opioid receptors of the basal ganglia modulate activity of dopaminergic neurones. Opioid induced rigidity, therefore, may be a form of drug-induced Parkinsonism. This has implications for the anaesthetic management of the patient with Parkinsonism. Previous descriptions of the anaesthetic management of Parkinsonism have emphasized the cardiovascular complications of L-Dopa therapy, but have not discussed the importance of opioids.