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NEUROSURGICAL ANESTHESIOLOGY AND NEUROSCIENCE

The Utility of Ketamine for the Preoperative Management of a Patient with Parkinson’s Disease

From the Department of Anesthesiology and Perioperative Medicine at the Medical University of South Carolina, Charleston, South Carolina.

Address correspondence and reprint requests to Matthew D. McEvoy, MD, MUSC, Department of Anesthesia and Perioperative Medicine, 167 Ashley Ave., PO Box 250912, Charleston, SC 29425. Address e-mail to mcevoymd{at}musc.edu.

Abstract

Loss of dopaminergic neurons from the substantia nigra characterizes the classical pathology of Parkinson’s disease, but persistent activation of N-methyl-d-aspartate receptors is also a major component. During difficult airway management in a patient with advanced Parkinson’s disease, the use of low-dose (20 mg) IV ketamine resulted in complete abolition of severe tremor and dysarthria. This led to the current case report in which low-dose ketamine was used for preoperative sedation and dyskinesia attenuation. Prior research and our experience would suggest that low-dose ketamine, titrated to effect, may provide optimal patient comfort and perioperative control of Parkinsonian tremor.