Perioperatives Management von Parkinson-Patienten

Zusammenfassung

Sowohl Patienten als auch deren Angehörige und insbesondere die behandelnden Ärzte haben hohen Respekt bezüglich der Komplikationsrate bei chirurgischen Eingriffen bei Parkinson-Patienten. Problematisch ist dabei insbesondere das plötzliche Absetzen von Antiparkinsonmitteln, das zu vielfältigen Störungen, nicht zuletzt akinetischen Krisen führen kann. Es gibt eine Vielzahl probater Methoden, um selbst bei nüchternen Patienten eine Fortsetzung der Dopamin-Ersatztherapie zu gewährleisten. Dazu gehören rektal appliziertes Levodopa, Amantadin-Infusionen und insbesondere die Verwendung des Rotigotin-Pflasters. Das perioperative Management von Parkinson-Patienten ist deshalb so wichtig, weil in Deutschland jährlich 10 000 Parkinson-Patienten einen operativen Eingriff erhalten. Hauptgründe dafür sind Frakturen, aber auch elektive Eingriffe. Weitere Notfallsituationen bei Parkinson-Patienten sind psychische Auffälligkeiten, motorische Krisen, aber auch Pneumonien und kardiale Störungen. Demgegenüber sind Krebserkrankungen bei Parkinson-Patienten eher selten anzutreffen.

Abstract

Both patients and caregivers but also treating physicians are concerned about complications along with surgical interventions. A major problem is abrupt cessation of anti-Parkinson medication, which leads to manifold disturbances, sometimes even to an akinetic crisis. There are several means to guarantee continuous dopaminergic stimulation even in patients that are not allowed to take medication orally before they undergo surgery. Amongst others rectally applied levodopa, amantadine infusions, and especially the use of a rotigotine patch are good means to overcome oral intake. Perioperative management is important due to the fact that in Germany alone each year more than 10 000 PD patients undergo surgery. Main reasons for this are fractures, but also elective interventions. Further emergency situations that cause treatment as an inpatient are psychosis, motoric disability, but also pneumonia and cardiovascular disturbances. In contrast PD patients suffer less often from cancer.

Schlüsselwörter

idiopathisches Parkinson-Syndrom - perioperatives Management - Anästhesie - Rotigotin

Key words

idiopathic Parkinson syndrome - perioperative management - anaesthesia - rotigotine

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