PERIOPERATIVE PROBLEMS IN PARKINSONS-DISEASE AND THEIR MANAGEMENT - APOMORPHINE WITH RECTAL DOMPERIDONE

Objective: To present guidelines on the use of apomorphine in combinat ion with rectal domperidone in Parkinson's disease (PD) patients under going abdominal surgery and to review the perioperative problems encou ntered in such patients. Background: PD Patients undergoing abdominal surgery present a major therapeutic challenge. Because most antiparkin sonian medications must be withheld until the patient is able to resum e oral intake, resulting rigidity and akinesia as well as alterations in gastrointestinal motility, respiratory function and swallowing mech anisms predispose these patients to numerous serious postoperative com plications. We have found that parenteral apomorphine in combination w ith rectal domperidone markedly facilitates the care of these difficul t patients. Methods: Presentation of two illustrative cases with revie w of the literature. Resulted: A standardized protocol using subcutane ous apomorphine and rectal domperidone was used in two PD patients who underwent abdominal surgery. Excellent control of parkinsonian sympto matology ws obtained without side effects. The simplicity of the proto col was emphasized in our second patient who required urgent reoperati on; the surgery nursing staff was able to restart the apomorphine imme diately 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 ora l antiparkinson drugs increases patient comfort, facilitates nursing c are and may reduce serious postoperative complications.