Vulnerability of Parkinson Patients to Iatrogenic Adverse Events: Emphasis on the Perioperative Period through a Case Report

Abstract

Deep brain stimulator surgery represents an interesting option for medically resistant Parkinson’s disease patients, indisposed by “wearing-off” and motor fluctuations. Considering the neurodegenerative nature of PD, after approximately five years of natural disease evolution, one half to twothirds of patients develops this delayed complication. The occurrence of dyskinesia and motor fluctuations interferes with activities of the daily living, consequently impacting the quality of life. A high frequency chronic stimulation targeting the subthalamic nucleus, located ventral to the thalamus and involved in the basal ganglia system, generates the same outcome than an ablation of this structure. Despite the positive impact of DBS surgery on PD symptomatology, physicians should be mindful of the vulnerability of this particular population and promote thorough monitoring, especially during the perioperative phase. A thoughtful approach considering the pathophysiological mechanisms underlying PD is required in order to select an individual’s pharmacopoeia. We report the case of a 61 year-old male, known for seventeen year of evolving PD, who developed acutely a state of generalized symmetrical rigidity, with a predilection for axial and bulbar musculature. After a meticulous review of this patient’s pharmacologic profile, sufentanil was deemed the responsible agent.