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ID 47563
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A Case of a Combination of Wearing-Off-Like Symptoms and Autonomic Hyperreflexia Following Spinal Anesthesia for a Patient with Parkinson’s Disease Who is Treated by Deep Brain Stimulation
creator
Tajima, Minoru
Yanagidani, Tadao
Matunami, Katsuaki
Kondh, Hiroshi
Sasada, Syogo
Yakusue, Tomoko
Nagashima, Kenta
subject
パーキンソン病
脳深部刺激療法
脊髄幹麻酔
合併症
Parkinson’s disease
Deep brain stimulation
neuraxial analgesia
complications
NDC
Medical sciences
abstract
Deep brain stimulator (DBS) has been widely performed for various medically refractory movement disorders. We report a 70’s male patients with Parkinson’s disease (PD) treated by DBS in addition to anti-parkinsonian drugs who underwent transurethral lithotomy under spinal anesthesia twice. We canceled his usual medications for PD, therefore, his blood pressure was higher than usual. His DBS was turned off in the operation room before induction of anesthesia. Both anesthesia techniques for TUL surgeries were completed by spinal anesthesia used by 0.5% hyperbaric bupivacine. Immediately after spinal anesthesia in both surgeries, severe rigidity, airway obstruction and conscious change emerged. These complications were suspected wearing-off-likes symptoms of PD, which were proved because of spinal anesthesia itself and/or DBS off effects. Autonomic hyperreflexia with severe hypertension, abnormal sweating and excessive oral secretion was gradually appeared after infusion of normal saline to obtain surgical fields of view, however, these symptoms disappeared after the end of infusion. It was suspected that the adverse events were due to low effects of spinal anesthesia on autonomic nervous system degenerated by Parkinson’s disease. We turned on DBS immediately after the completion of surgeries, and resumed his oral medications on the next day of surgeries. There were no events in his courses. As there is little information and no standard anesthetic guidelines available on patients with DBS implant who are present for surgery, a careful management is needed to avoid complications.
description
本稿の要旨は日本麻酔科学会 中国・四国支部第55回学術集会(松山市,2018年)で発表した。
journal title
Ansesthesia and Resuscitation
volume
Volume 55
issue
Issue 1
start page
39
end page
43
date of issued
2019-03-01
publisher
広島麻酔医学会
issn
0385-1664
ncid
language
jpn
nii type
Journal Article
HU type
Journal Articles
DCMI type
text
format
application/pdf
text version
publisher
department
Graduate School of Biomedical & Health Sciences
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