A 72-year-old male with severe Parkinson’s disease is admitted to your ICU ventilated following emergency abdominal surgery. Enteral administration of medications is not possible.
List five potential problems specific to the Parkinson’s disease that may affect his acute and long-term post-op management. (25% marks)
1) severe muscle and trunk rigidity due to medication withdrawal
2) likely to be wasted and deconditioned
3) autonomic neuropathy and with CVS instability
4) gut failure and pseudo-obstruction
5) vocal cord dysfunction and upper airway dysfunction on extubation
6) failure of temperature regulation
7) greatly elevated risk of confusion
8) enhanced sedation effects and sensitivity
9) mobilisation and rehabilitation likely to be compromised.
In short, there are a lot more than five potential problems here. The PD patient is likely to have a plethora of problems, and the trainee is spoiled for choice.
Problems of routine housekeeping:
Freeman, William D., et al. "ICU management of patients with Parkinson's disease or Parkinsonism." Current Anaesthesia & Critical Care 18.5-6 (2007): 227-236.
Vincken, Walter G., et al. "Involvement of upper-airway muscles in extrapyramidal disorders: a cause of airflow limitation." New England Journal of Medicine 311.7 (1984): 438-442.
Katus, Linn, and Alexander Shtilbans. "Perioperative management of patients with Parkinson's disease." The American journal of medicine 127.4 (2014): 275-280.