http://news.nurse.com/article/201301...4/-1/frontpage

PD patients' surgery may conflict with medication

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," ...

"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...


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...

Never in my lifetime will I forget Tena crawling down the hall on her knees and back because of needing and not receiving her meds while in the hospital. Take your schedule in writing and put it in a small container around your neck and wear it at all times. Didn't work for her but may work for some.

I was admitted to ICU and when they brought me down to a regular patient room, with a blessed roommate, I did not receive my meds for 6 hours. I called the nurse about 3 or 4 times and asked for them. The first time I requested them she said she the nurse on the shift before her had not sent my med list to the pharmacy. The second request met with the pharmacy sends meds for all patients' med at the same time.

My call light stopped working and the nurse ignored my pleas for two more hours. My roommate and her family became deeply concerned when my moans and pleas became slowly quiter and soon the thrashing in my bed stopped. This time they called the nurse and asked why I could not have my meds. When the nurse came over to check on me I was curled in a small balll and blood oxygen level was under 90%. I was gasping to pull oxyigen into my lungs. That made her move. I had my meds 5 minutes later and thanked my room mate and her family for their concern.

Dianna