NWPF

News ArchivesRead News

PD patients' surgery may conflict with medication

Thursday January 10, 2013

Nurse.com - Clinicians should carefully consider the scheduling of surgery for Parkinson’s disease patients to ensure optimal treatment with carbidopa-levodopa (Sinemet), the "gold-standard treatment" for PD, according to a study.

Researchers with the University of Minnesota School of Nursing and the university’s medical school conducted a study to establish clear guidelines regarding perioperative symptom management in PD patients, who may miss several doses of carbidopa-levodopa when put on NPO (nil per os, or nothing-by-mouth) status for surgery.

"One concern with carbidopa-levodopa is its short, one-to-two-hour half-life, requiring dosing several times per day," the researchers wrote in the January issue of the American Journal of Nursing

"Moreover, because of wide variability in patients’ responses to this and other antiparkinson medications, individual regimens may be quite complex. Some regimens require frequent administration, alternating short-acting and sustained-release doses of carbidopa-levodopa. The complex medication regimens are of particular concern when a patient with Parkinson’s disease must remain on NPO status for several hours postoperatively."

Kathleen Fagerlund, RN, PhD, Lisa Carney Anderson, PhD, and Olga Gurvich, MA, conducted a retrospective review of patient electronic health records at a Midwestern public medical center, finishing with a sample of 89 surgical events in 67 PD patients who had undergone any type of surgery aside from PD-related surgery and were taking carbidopa-levodopa.

They found the median duration of carbidopa-levodopa withholding was 12.35 hours — more than 16 hours for patients undergoing inpatient procedures and more than 11 hours for those undergoing outpatient procedures.

"Given the implications of prolonged withholding times on the therapeutic effects of carbidopa-levodopa, researchers and clinicians must ask how such times can be reduced," the authors wrote. "Operating room personnel, particularly certified registered nurse anesthetists, must be mindful that patients with Parkinson’s disease can take carbidopa-levodopa and other antiparkinson medications with a sip of water until shortly before the initiation of anesthesia; and in many cases these medications can be resumed in the postanesthesia recovery unit. In the presence of gastric discomfort, nausea or vomiting, an orally disintegrating preparation of carbidopa-levodopa could be considered."

Most surgical procedures began at 9 a.m. or later, with only 14% starting between 6 a.m. and 9 a.m. The most commonly reported exacerbation of PD symptoms was agitation or confusion.

The researchers concluded that for best symptom management, clinicians should schedule surgery on PD patients for as early in the day as possible, administer medications as close to the patient’s usual dosing schedule as possible and provide nursing education about optimal medication management for this patient population.

"Nurses can and should take the lead in ensuring that patients with Parkinson’s disease receive their medications on time, that disruptions to the regimen are minimized and that optimal symptom management is achieved," they wrote.

Recent News

May 2 - What's Good For The Heart Is Good For The Brain
Apr 29 - Press Release: FDA approves first drug to treat hallucinations and delusions associated with Parkinson’s disease
Apr 28 - Dopamine-making neurons can be chemically controlled in animal model of Parkinson's
Apr 25 - Lifestyle: Dating with Disease
Apr 25 - Scientific breakthrough in fight against Parkinson's and Alzheimer's
Apr 20 - Breakthrough Parkinson's disease blood test
Apr 12 - Tissue biomarker for dementia with Lewy bodies and Parkinson’s disease
Apr 11 - Yoga for Every Body: Experts say yoga can ease pain and improve mobility for people with neurologic conditions
Apr 9 - Commonly prescribed Parkinson's drugs up risk of compulsive gambling, shopping, binge eating, hypersexuality
Apr 7 - Pfizer and IBM Launch Innovative Research Project to Transform Parkinson's Disease Care
Apr 7 - Parkinson's Drug Highly Effective for Resistant Depression
Apr 5 - Speech therapy program helps Parkinson’s patients regain speaking ability
Apr 4 - New research maps out pesticide exposure and Parkinson's disease in Nebraska
Apr 4 - The rogue immune cells that wreck the brain
Mar 28 - Chemists identify structure of protein that forms fibrils in Parkinson's patients
Mar 25 - UPDATE 1-FDA staff says Acadia's drug for Parkinson's disease psychosis is effective
Mar 23 - The virus that could cure Alzheimer's, Parkinson's and more
Mar 21 - Antipsychotic drugs may do significantly more harm to Parkinson's disease patients
Mar 21 - Rosacea Might Boost Parkinson's Risk: Study
Mar 21 - Apple CareKit Could Completely Change What It's Like To Live With Parkinson's Disease & Epilepsy