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Perioperative problems in Parkinson's disease and their management: apomorphine with rectal domperidone
1Motton and Gloria Shulman Movement Disorders Centre, Toronto Hospital, University of Toronto, Ontario, Canada.
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.