脳深部刺激療法を留置したパーキンソン病患者の脊髄くも膜下麻酔中にウエアリングオフ様症状と自律神経反射亢進症状を合併した1症例

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.