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Postoperative Stridor and Acute Respiratory Failure After Parkinson Disease Deep Brain Stimulator Placement: Case Report and Review of Literature.
World Neurosurg. 2018 Mar; 111:22-25.WN

Abstract

BACKGROUND

Parkinson disease (PD), a neurodegenerative disorder characterized by loss of dopaminergic neurons in the substantia nigra of the midbrain, is commonly thought of as a motion disorder, but it can have significant effect on the respiratory system. Respiratory failure is the most common cause of death in these patients, but it can also affect laryngeal function causing dysphonia, dysphagia, and dysarthric speech. Acute upper airway obstruction is a rare finding in PD, especially in the perioperative settings. In this article we report a PD patient who developed upper respiratory obstruction postoperatively. We also review the literature and highlight the importance of preoperative evaluation to identify patients who may be at risk of this complication.

CASE DESCRIPTION

We describe a PD patient presenting for brain stimulation electrode implantation under general anesthesia, who postoperatively developed stridor and near complete upper airway obstruction despite maintenance of oral anti-Parkinson medication regimen intraoperatively. The patient was reintubated in post-anesthesia-care unit, and tracheostomy was performed after 1 week due to persistent vocal cord dysfunction.

CONCLUSIONS

Baseline vocal cord impairment in PD patients can be acutely aggravated perioperatively. Symptoms such as dysphagia and dysarthria, which can indicate susceptibility to postoperative upper airway obstruction, may not be well recognized by the patient and family. Surgical candidates should be carefully interviewed preoperatively, and watchful monitoring of respiratory function intraoperatively and postoperatively is of paramount importance. Neurosurgical and neuroanesthesia team should be aware of, and prepared to manage, this potentially life-threatening airway obstruction in PD patients.

Authors+Show Affiliations

Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA.Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA.Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA.Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA.Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA.Department of Otolaryngology, Cleveland Clinic, Cleveland, Ohio, USA.Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA. Electronic address: AVITSIR@ccf.org.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

29229347

Citation

Wang, Mi, et al. "Postoperative Stridor and Acute Respiratory Failure After Parkinson Disease Deep Brain Stimulator Placement: Case Report and Review of Literature." World Neurosurgery, vol. 111, 2018, pp. 22-25.
Wang M, Saasouh W, Botsford T, et al. Postoperative Stridor and Acute Respiratory Failure After Parkinson Disease Deep Brain Stimulator Placement: Case Report and Review of Literature. World Neurosurg. 2018;111:22-25.
Wang, M., Saasouh, W., Botsford, T., Keebler, A., Zura, A., Benninger, M. S., & Avitsian, R. (2018). Postoperative Stridor and Acute Respiratory Failure After Parkinson Disease Deep Brain Stimulator Placement: Case Report and Review of Literature. World Neurosurgery, 111, 22-25. https://doi.org/10.1016/j.wneu.2017.11.176
Wang M, et al. Postoperative Stridor and Acute Respiratory Failure After Parkinson Disease Deep Brain Stimulator Placement: Case Report and Review of Literature. World Neurosurg. 2018;111:22-25. PubMed PMID: 29229347.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Postoperative Stridor and Acute Respiratory Failure After Parkinson Disease Deep Brain Stimulator Placement: Case Report and Review of Literature. AU - Wang,Mi, AU - Saasouh,Wael, AU - Botsford,Thomas, AU - Keebler,Allen, AU - Zura,Andrew, AU - Benninger,Michael S, AU - Avitsian,Rafi, Y1 - 2017/12/09/ PY - 2017/10/04/received PY - 2017/11/27/revised PY - 2017/11/30/accepted PY - 2017/12/13/pubmed PY - 2018/5/16/medline PY - 2017/12/13/entrez KW - Acute respiratory failure KW - Parkinson disease KW - Postoperative KW - Stridor SP - 22 EP - 25 JF - World neurosurgery JO - World Neurosurg VL - 111 N2 - BACKGROUND: Parkinson disease (PD), a neurodegenerative disorder characterized by loss of dopaminergic neurons in the substantia nigra of the midbrain, is commonly thought of as a motion disorder, but it can have significant effect on the respiratory system. Respiratory failure is the most common cause of death in these patients, but it can also affect laryngeal function causing dysphonia, dysphagia, and dysarthric speech. Acute upper airway obstruction is a rare finding in PD, especially in the perioperative settings. In this article we report a PD patient who developed upper respiratory obstruction postoperatively. We also review the literature and highlight the importance of preoperative evaluation to identify patients who may be at risk of this complication. CASE DESCRIPTION: We describe a PD patient presenting for brain stimulation electrode implantation under general anesthesia, who postoperatively developed stridor and near complete upper airway obstruction despite maintenance of oral anti-Parkinson medication regimen intraoperatively. The patient was reintubated in post-anesthesia-care unit, and tracheostomy was performed after 1 week due to persistent vocal cord dysfunction. CONCLUSIONS: Baseline vocal cord impairment in PD patients can be acutely aggravated perioperatively. Symptoms such as dysphagia and dysarthria, which can indicate susceptibility to postoperative upper airway obstruction, may not be well recognized by the patient and family. Surgical candidates should be carefully interviewed preoperatively, and watchful monitoring of respiratory function intraoperatively and postoperatively is of paramount importance. Neurosurgical and neuroanesthesia team should be aware of, and prepared to manage, this potentially life-threatening airway obstruction in PD patients. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/29229347/Postoperative_Stridor_and_Acute_Respiratory_Failure_After_Parkinson_Disease_Deep_Brain_Stimulator_Placement:_Case_Report_and_Review_of_Literature_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(17)32109-5 DB - PRIME DP - Unbound Medicine ER -