PATIENT CONDITIONS :P

Question 1

PARKINSON’S

Answer 1

Multisystem degenerative disease due to loss of dopaminergic neurons

Early, Late, End Stage PD

Airway = Aspiration risk due to laryngeal/pharyngeal dysfunction, unable to clear secretions –> aspiration & post extubating laryngospasm.
+ Rigidity and fixed flexion deformity –> difficult intubation

Resp = Restrictive lung disease due to rigidity, bradykinesia of resp muscles. OSA is common

CVS = orthostatic hypotension which may be due to parkinsons drugs, increased risk of intraop hypotension. Arrthymias

CNS - greater risk of postop delirium and hallucinations

GIT - Sialorrhoea - drooling - may need glycopyrolate, Neostigmine increases viscosity which may impair swallowing.

Postop ileus or delayed gastric emptying –> decreased absorption of drugs

DRUGS
PREVENT WITHDRAWL
DONT GIVE DOPAMINE ANTAGONISTS!

Induction - propofol safe, may get more hypotension,
Analgesia
GA vs Neuraxial - tremor, medications , hypotension.

Question 2

MYOTONIC DYSTROPHY

Answer 2

Type of muscular dystrophy, genetic, inablility of muscle to relax after contraction

Cardiac arrhythmias - mostly Afib/Aflutter progressive - cardiomyopathy - LVH RWMD check ECG -

Restrictive lung disease - ventilatory failure and poor airway protection. arterial hypoxia and diminished response.

GIT dysmotility and decreased emptying -> risk of aspitation

Airway (DM1) - narrow facies , high arched palate and limited mouth opening.

CNS - hypersomnia 2nd central hypersomnia, sleep related ventilation insufficients, OSA, –> periop risk
potential for encephalopathy

Assessment

Lung disease - RFTs, reqiurement of BiPAP

Drugs - variable response to Sux - avoid - can cause contractions!
VERY Sensitive to OPIOIDS/BENZOS

PERIOP
Hypothermia = contractions - warm OT
NMT monitoring can induce contraction!
Propofol SAfe -decrease dose
aspiration risk - RSI
Volatiles ok
Neostigmine - may induce myotonia - sugammadex
Extubation - ?keep ventilated
Pain - minimise opioids
HDU