Case ReportPostoperative Stridor and Acute Respiratory Failure After Parkinson Disease Deep Brain Stimulator Placement: Case Report and Review of Literature
Introduction
Any potential risk of significant airway compromise in the perioperative period warrants thorough investigation, optimization, and a management plan that may involve multidisciplinary efforts.
Parkinson disease (PD) is the second most common movement disorder. The cause of PD is unknown, but it involves dopaminergic neuron destruction in the substantia nigra, locus ceruleus, and other brain centers.1 Dysphagia and dysarthria occur frequently as results of motor control impairment of the larynx and other components of the upper airway. Approximately 90% of persons with PD will develop dysarthria during the course of the disease; however, patients themselves may be unaware of any speech problems.2
Perioperative stresses related to surgery and anesthesia represent a significant hazard for PD patients, including deterioration in respiratory function. It has been reported that these patients are susceptible to pulmonary aspiration, laryngospasm, and altered function of the ventilatory muscles, resulting in an obstructive breathing pattern,3 but near to complete upper airway obstruction is rarely seen. We report a case where a PD patient was reintubated postoperatively (postop) in the post anesthesia care unit (PACU) and subsequently undergoing a tracheostomy due to such complications after deep brain stimulator (DBS) placement.
Section snippets
Case Description
A 71-year-old Arabic-speaking female with a 13-year history of PD treated with carbidopa-levodopa, amantadine, and entacapone presented as a candidate for DBS treatment due to uncontrolled dyskinesias. During preoperative discussion, the patient adamantly refused awake craniotomy due to her concerns of language barrier and cultural differences. Therefore the consensus was to place bilateral DBS under magnetic resonance imaging guidance in an intraoperative magnetic resonance imaging suite.
Discussion
PD is a progressive, neurodegenerative disorder caused by loss of dopamine-producing neurons in the brain. Respiratory abnormalities have been well described since the initial description of PD in 1817.4 Respiratory complication, especially aspiration pneumonia, is the most common cause of death in PD patients.5, 6
It is well known that PD can affect the larynx, leading to dysphonia and dysphagia. Surprisingly, however, symptomatic upper airway obstruction is not common in PD. Little is known
Conclusion
As the elderly population grows, inevitably we will encounter increasing numbers of PD surgical patients. Parkinson disease–related stridor and acute upper airway obstruction are rare but potentially can be lethal if not recognized early and managed appropriately. The purpose of our case report is to raise awareness of such significant complications. We therefore recommend the following steps when caring for surgical patients with long-standing PD: 1) careful preoperative evaluation of PD
Acknowledgment
We would like to thank Theresa M. Kline, MLIS for helping with the literature search.
References (18)
- et al.
Parkinson's disease
Lancet (London, England)
(2015) - et al.
Respiratory dysfunction in Parkinson's disease
J Royal Coll Physic Edinburgh
(2017) - et al.
Perioperative management of Parkinson's disease
Expert Rev Neurotherapeutics
(2017) An essay on the shaking palsy. 1817
J Neuropsychiatry Clin Neurosci
(2002)- et al.
Pulmonary function in Parkinson's syndrome: the effect of thalamotomy
Can Med Assoc J
(1968) - et al.
Parkinsonism: onset, progression, and mortality. 1967
Neurology
(2001) - et al.
Persistent perioperative laryngospasm in a patient with Parkinson's disease
Can J Anaesth
(1998) - et al.
Upper airway involvement in Parkinson's disease resulting in postoperative respiratory failure
Can J Anaesth
(1995) - et al.
Stridor in Parkinson's disease: a case of ‘dry drowning’?
J Laryngol Otol
(2010)
Cited by (4)
A Pragmatic Approach to the Perioperative Management of Parkinson's Disease
2021, Canadian Journal of Neurological SciencesProgression of respiratory disorders associated with Parkinson's disease
2022, Chinese Journal of Contemporary Neurology and NeurosurgeryQuantifying Stridor Associated with Parkinsonism and Deep Brain Stimulation—A Case Report
2022, Movement Disorders Clinical PracticeMovement Disorder Emergencies of the Upper Aerodigestive Tract
2022, Current Clinical Neurology
Conflict of interest statement: The authors do not have any conflicts of interest and the manuscript is not supported by any federal or industrial grants. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.