Parkinson’s disease: perioperative management

Parkinson’s disease (PD) is a progressive, neurodegenerative disease associated with loss of dopaminergic neurons and the presence of Lewy bodies within the substantia nigra and other areas of the brain and peripheral autonomic nervous system.1 Cardinal clinical features include rigidity, bradykinesia, and resting tremor. A supportive feature is a consistent response to levodopa. Postural instability, cognitive impairment, and autonomic dysfunction usually occur later in the disease. As the population ages, PD is becoming more prevalent, affecting approximately 1% of individuals older than 60.2 These patients pose a specific challenge to hospital staff, not only because the multi-organ system manifestations of PD can