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PD – Peri-Operative Medication Management — SCE Neurology MCQ

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ModerateMovement DisordersPD – Peri-Operative Medication ManagementSCE Neurology

A 70-year-old man with Parkinson's disease is admitted to hospital for hip replacement. His usual medications are co-careldopa 25/100 QDS at 7am, 11am, 3pm, 7pm, and ropinirole 4 mg TDS. He is nil-by-mouth from midnight for morning surgery. What medication management plan should be in place?

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Correct answer: E — PD medications must be given pre-operatively — co-careldopa can be given with a sip of water up to 2 hours before anaesthesia (as per most anaesthetic guidelines); alternatively, a rotigotine transdermal patch can be applied as bridge therapy; ropinirole should also be continued or covered with a patch. Post-operatively, PD medications must be restarted as soon as the patient can take oral medications

Peri-operative PD medication management is critical. Levodopa can be given with a sip of water up to 2 hours before anaesthesia (it is on the list of essential medications not withheld pre-operatively). If prolonged nil-by-mouth is anticipated, rotigotine transdermal patch provides continuous dopaminergic stimulation. SC apomorphine can be used for rescue. Post-operatively, PD medications must be restarted at the earliest opportunity. Omission risks parkinsonism-hyperpyrexia syndrome. A: Omission is dangerous. C: Same-day restart is essential. D: IV levodopa does not exist as a standard preparation. E: Critically important.

Reference: NICE NG71; Parkinson's UK Peri-operative Guidance; NHS Patient Safety Alert