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>Revistas >Gaceta Médica de México >Año 2013, No. 3

González-Latapi P, Cervantes-Arriaga A, Rodríguez-Violante M
Consideraciones perioperatorias en pacientes con enfermedad de Parkinson: implicaciones farmacológicas
Gac Med Mex 2013; 149 (3)

Idioma: Español
Referencias bibliográficas: 70
Paginas: 334-343
Archivo PDF: 102.27 Kb.

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Los procedimientos quirúrgicos en pacientes con enfermedad de Parkinson (EP) son frecuentes. El manejo perioperatorio de la EP requiere del conocimiento de la patología así como de las propiedades farmacológicas de los medicamentos utilizados. Dado el riesgo de complicaciones y la complejidad del manejo antiparkinsónico en un paciente con EP sometido a un procedimiento quirúrgico, es necesario establecer un abordaje sistematizado. En la presente revisión se describen las características farmacocinéticas y farmacodinámicas de los medicamentos utilizados para el tratamiento de los pacientes con EP. Se sugieren estrategias para el manejo farmacológico en los periodos preoperatorio, transoperatorio y postoperatorio. Finalmente, se hace referencia a las alternativas al tratamiento con sustitución dopaminérgica.

Palabras clave: Enfermedad de Parkinson, Cirugía, Manejo perioperatorio, Complicaciones no motoras, Complicaciones motoras.


  1. De Lau LM, Breteler MM. Epidemiology of Parkinson’s disease. Lancet Neurol. 2006;5(6):525-35.

  2. Gerlach OH, Broen MP, Van Domburg PH, Vermeij AJ, Weber WE. Deterioration of Parkinson’s disease during hospitalization: survey of 684 patients. BMC Neurol. 2012;12(13).

  3. Mariscal A, Medrano IH, Canovas AA, et al. Perioperative management of Parkinson’s disease. Neurologia. 2012;27(1):46-50.

  4. Holland J. Care of patients with Parkinson’s disease in the operating department. J Perioper Pract. 2010;20(11):406-10.

  5. Frucht SJ. Movement disorder emergencies in the perioperative period. Neurol Clin. 2004;22(2):379-87.

  6. Derry CP, Shah KJ, Caie L, Counsell CE. Medication management in people with Parkinson’s disease during surgical admissions. Postgrad Med J. 2010;86(1016):334-7.

  7. Lieb K, Selim M. Preoperative evaluation of patients with neurological disease. Semin Neurol. 2008;28(5):603-10.

  8. Gálvez-Jiménez N, Lang AE. The perioperative management of Parkinson›s disease revisited. Neurol Clin. 2004;22(2):367-77.

  9. Cheung YF, Hui CH, Chan JH. Parkinsonism-hyperpyrexia syndrome due to abrupt withdrawal of amantadine. Hong Kong Med J. 2011;17(2):167-8.

  10. Rabinak CA, Nirenberg MJ. Dopamine agonist withdrawal syndrome in Parkinson disease. Arch Neurol. 2010;67(1):58-63.

  11. Toru M, Matsuda O, Makiguchi K, Sugano K. Neuroleptic malignant syndrome-like state following a withdrawal of antiparkinsonian drugs. J Nerv Ment Dis. 1981;169(5):324-7.

  12. Henderson VW, Wooten GF. Neuroleptic malignant syndrome: a pathogenetic role for dopamine receptor blockade? Neurology. 1981;31(2):132-7.

  13. Fujitake J, Kuno S, Nishitani H. Neuroleptic malignant syndrome-like state in eight patients with parkinsonism. Rinsho Shinkeigaku. 1984;24(4):371-8.

  14. Sechi GP, Tanda F, Mutani R. Fatal hyperpyrexia after withdrawal of levodopa. Neurology. 1984;34(2):249-51.

  15. Figa-Talamanca L, Gualandi C, Di Meo L, Di Battista G, Neri G, Lo Russo F. Hyperthermia after discontinuance of levodopa and bromocriptine therapy: impaired dopamine receptors a possible cause. Neurology. 1985;35(2):258-61.

  16. Keyser DL, Rodnitzky RL. Neuroleptic malignant syndrome in Parkinson›s disease after withdrawal or alteration of dopaminergic therapy. Arch Intern Med. 1991;151(4):794-6.

  17. Ikebe S, Harada T, Hashimoto T, et al. Prevention and treatment of malignant syndrome in Parkinson›s disease: a consensus statement of the malignant syndrome research group. Parkinsonism Relat Disord. 2003;9 Suppl 1:47-9.

  18. Thobois S, Ardouin C, Lhommee E, et al. Non-motor dopamine withdrawal syndrome after surgery for Parkinson›s disease: predictors and underlying mesolimbic denervation. Brain. 2010;133(Pt 4):1111-27.

  19. Pondal M, Marras C, Miyasaki J, et al. Clinical features of dopamine agonist withdrawal syndrome in a movement disorders clinic. J Neurol Neurosurg Psychiatry. 2013 Feb;84(2):130-5.

  20. Brennan KA, Genever RW. Managing Parkinson›s disease during surgery. BMJ. 2010;341:c5718.

  21. Shaikh SI, Verma H. Parkinson›s disease and anaesthesia. Indian J Anaesth. 2011;55(3):228-34.

  22. Katzenschlager R, Lees AJ. Treatment of Parkinson›s disease: levodopa as the first choice. J Neurol. 2002;249 Suppl 2:19-24.

  23. Djaldetti R, Baron J, Ziv I, Melamed E. Gastric emptying in Parkinson›s disease: patients with and without response fluctuations. Neurology. 1996;46(4):1051-4.

  24. Deleu D, Northway MG, Hanssens Y. Clinical pharmacokinetic and pharmacodynamic properties of drugs used in the treatment of Parkinson›s disease. Clin Pharmacokinet. 2002;41(4):261-309.

  25. Astarloa R, Mena MA, Sánchez V, De la Vega L, De Yébenes JG. Clinical and pharmacokinetic effects of a diet rich in insoluble fiber on Parkinson disease. Clin Neuropharmacol. 1992;15(5):375-80.

  26. Axelrod J. Methylation reactions in the formation and metabolism of catecholamines and other biogenic amines. Pharmacol Rev. 1966;18(1):95-113.

  27. Kaakkola S. Clinical pharmacology, therapeutic use and potential of COMT inhibitors in Parkinson’s disease. Drugs. 2000;59(6):1233-50.

  28. Nutt JG, Woodward WR, Anderson JL. The effect of carbidopa on the pharmacokinetics of intravenously administered levodopa: the mechanism of action in the treatment of parkinsonism. Ann Neurol. 1985;18(5): 537-43.

  29. Cedarbaum JM. Clinical pharmacokinetics of anti-parkinsonian drugs. Clin Pharmacokinet. 1987;13(3):141-78.

  30. Nutt JG, Fellman JH. Pharmacokinetics of levodopa. Clin Neuropharmacol. 1984;7(1):35-49.

  31. Ahlskog JE, Muenter MD. Frequency of levodopa-related dyskinesias and motor fluctuations as estimated from the cumulative literature. Mov Disord. 2001;16(3):448-58.

  32. Khan TS. Off spells and dyskinesias: pharmacologic management of motor complications. Cleve Clin J Med. 2012;79 Suppl 2:8-13.

  33. Ondo WG, Shinawi L, Moore S. Comparison of orally dissolving carbidopa/ levodopa (Parcopa) to conventional oral carbidopa/levodopa: a single-dose, double-blind, double-dummy, placebo-controlled, crossover trial. Mov Disord. 2010;25(16):2724-7.

  34. Stocchi F, Vacca L, Ruggieri S, Olanow CW. Intermittent vs. continuous levodopa administration in patients with advanced Parkinson disease: a clinical and pharmacokinetic study. Arch Neurol. 2005;62(6):905-10.

  35. Olanow CW, Obeso JA, Stocchi F. Continuous dopamine-receptor treatment of Parkinson’s disease: scientific rationale and clinical implications. Lancet Neurol. 2006;5(8):677-87.

  36. Devos D. Patient profile, indications, efficacy and safety of duodenal levodopa infusion in advanced Parkinson’s disease. Mov Disord. 2009;24(7):993-1000.

  37. Lange KW. Clinical pharmacology of dopamine agonists in Parkinson’s disease. Drugs Aging. 1998;13(5):381-9.

  38. Clarke CE, Guttman M. Dopamine agonist monotherapy in Parkinson’s disease. Lancet. 2002;360(9347):1767-9.

  39. Andreotti AC, Pianezzola E, Persiani S, Pacciarini MA, Strolin Benedetti M, Pontiroli AE. Pharmacokinetics, pharmacodynamics, and tolerability of cabergoline, a prolactin-lowering drug, after administration of increasing oral doses (0.5, 1.0, and 1.5 milligrams) in healthy male volunteers. J Clin Endocrinol Metab. 1995;80(3):841-5.

  40. Friis ML, Gron U, Larsen NE, Pakkenberg H, Hvidberg EF. Pharmacokinetics of bromocriptine during continuous oral treatment of Parkinson’s disease. Eur J Clin Pharmacol. 1979;15(4):275-80.

  41. Kaye CM, Nicholls B. Clinical pharmacokinetics of ropinirole. Clin Pharmacokinet. 2000;39(4):243-54.

  42. Burns RS, Gopinathan G, Humpel M, Dorow R, Calne DB. Disposition of oral lisuride in Parkinson’s disease. Clin Pharmacol Ther. 1984;35(4): 548-56.

  43. Langtry HD, Clissold SP. Pergolide. A review of its pharmacological properties and therapeutic potential in Parkinson’s disease. Drugs. 1990;39(3):491-506.

  44. Jenner P. Parkinson’s disease: pathological mechanisms and actions of piribedil. J Neurol. 1992;239 Suppl 1:2-8.

  45. Bennett JP Jr, Piercey MF. Pramipexole – A new dopamine agonist for the treatment of Parkinson’s disease. J Neurol Sci. 1999;163(1):25-31.

  46. Nissinen E, Linden IB, Schultz E, Pohto P. Biochemical and pharmacological properties of a peripherally acting catechol-O-methyltransferase inhibitor entacapone. Naunyn Schmiedebergs Arch Pharmacol. 1992;346(3):262-6.

  47. Marsala SZ, Gioulis M, Ceravolo R, Tinazzi M. A systematic review of catechol-O-methyltransferase inhibitors: efficacy and safety in clinical practice. Clin Neuropharmacol. 2012;35(4):185-90.

  48. Hoy SM, Keating GM. Rasagiline: a review of its use in the treatment of idiopathic Parkinson’s disease. Drugs. 2012;72(5):643-69.

  49. Mahmood I. Clinical pharmacokinetics and pharmacodynamics of selegiline. An update. Clin Pharmacokinet. 1997;33(2):91-102.

  50. Jankovic J, Poewe W. Therapies in Parkinson’s disease. Curr Opin Neurol. 2012;25(4):433-47.

  51. Pfeiffer RF. Antiparkinsonian agents. Drug interactions of clinical significance. Drug Saf. 1996;14(5):343-54.

  52. Schwab RS, Poskanzer DC, England AC Jr, Young RR. Amantadine in Parkinson’s disease. Review of more than two years’ experience. JAMA. 1972;222(7):792-5.

  53. Aoki FY, Sitar DS. Clinical pharmacokinetics of amantadine hydrochloride. Clin Pharmacokinet. 1988;14(1):35-51.

  54. Chaudhuri KR. Autonomic dysfunction in movement disorders. Curr Opin Neurol. 2001;14(4):505-11.

  55. Ha AD, Brown CH, York MK, Jankovic J. The prevalence of symptomatic orthostatic hypotension in patients with Parkinson’s disease and atypical parkinsonism. Parkinsonism Relat Disord. 2011;17(8):625-8.

  56. Burton DA, Nicholson G, Hall GM. Anaesthesia in elderly patients with neurodegenerative disorders: special considerations. Drugs Aging. 2004;21(4):229-42.

  57. Shibao C, Gamboa A, Diedrich A, Biaggioni I. Management of hypertension in the setting of autonomic dysfunction. Curr Treat Options Cardiovasc Med. 2006;8(2):105-9.

  58. Nicholson G, Pereira AC, Hall GM. Parkinson’s disease and anaesthesia. Br J Anaesth. 2002;89(6):904-16.

  59. Muravchick S, Smith DS. Parkinsonian symptoms during emergence from general anesthesia. Anesthesiology. 1995;82(1):305-7.

  60. Mason LJ, Cojocaru TT, Cole DJ. Surgical intervention and anesthetic management of the patient with Parkinson’s disease. Int Anesthesiol Clin. 1996;34(4):133-50.

  61. Gravlee GP. Succinylcholine-induced hyperkalemia in a patient with Parkinson’s disease. Anesth Analg. 1980;59(6):444-6.

  62. Muzzi DA, Black S, Cucchiara RF. The lack of effect of succinylcholine on serum potassium in patients with Parkinson’s disease. Anesthesiology. 1989;71(2):322.

  63. Seppi K, Weintraub D, Coelho M, et al. The movement disorder society evidence-based medicine review update: treatments for the non-motor symptoms of Parkinson’s disease. Mov Disord. 2011;26 Suppl 3:42-80.

  64. Klausner JM, Caspi J, Lelcuk S, et al. Delayed muscular rigidity and respiratory depression following fentanyl anesthesia. Arch Surg. 1988;123(1):66-7.

  65. Haq IU, Lewitt PA, Fernández HH. Apomorphine therapy in Parkinson›s disease: a review. Expert Opin Pharmacother. 2007;8(16):2799-809.

  66. Gallagher DA, Schrag A. Psychosis, apathy, depression and anxiety in Parkinson›s disease. Neurobiol Dis. 2012;46(3):581-9.

  67. Kalenka A, Schwarz A. Anaesthesia and Parkinson›s disease: how to manage with new therapies? Curr Opin Anaesthesiol. 2009;22(3):419-24.

  68. Elshoff JP, Braun M, Andreas JO, Middle M, Cawello W. Steady-state plasma concentration profile of transdermal rotigotine: an integrated analysis of three, open-label, randomized, phase I multiple dose studies. Clin Ther. 2012;34(4):966-78.

  69. Korczyn AD, Reichmann H, Boroojerdi B, Hack HJ. Rotigotine transdermal system for perioperative administration. J Neural Transm. 2007; 114(2):219-21.

  70. Wullner U, Kassubek J, Odin P, et al. Transdermal rotigotine for the perioperative management of Parkinson›s disease. J Neural Transm. 2010;117(7):855-9.

>Revistas >Gaceta Médica de México >Año2013, No. 3

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