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Topic Anesthetics and sedation Go to previous topic Go to next topic Go to higher level

By in-faith On 2009.11.24 12:10
Last Friday my MIL ended up in emerg. with chest pain. They think it is just gastro related, but are now wanting to do a scope with "conscious sedation" (whatever that is). Does anyone have any experience/advice regarding "conscious sedation" or needles in a dentist office?

By annwood On 2009.11.24 14:22
My son is a nurse anesthesist. He will be here tonight and I will ask him about conscious sedation and novacaine. Get back to you soon.

By in-faith On 2009.11.24 15:19
Thanks very much annwood.

By annwood On 2009.11.24 23:06
Here is the word. Narcotics should always be avoided in PD pts. Narcotis and antiemitcs (used for nausea) are considered to be antagonists to dopamine (it either negates the effects or decreases the transmission of dopamine). The best drug to use for anesthesia in PD is Ketamine but even that one has been reported to cause an exaggerated sympathetic nervous system response. PD pts should be allowed to take their oral medications up until 20 min. before surgery and if the surgery is going to be longer than 6 hrs Sinemet should be administered in the OR.

If there is dementia or mental confusion, sedative drugs should rarely be administered as further mental confusion could result.

Source: "Anesthesia and Co-Existing Disease" by Robt. K. Stoelting and Stephen F. Dierdorf.

Conscious anesthesia is used for upper and lower GI's and other minor procedures. It is usually Versaid and Demerol. The patient is awake but the drugs result in amnesia and the pt does not remember the procedure.

Novacaine is used in dental procedures but is eventually absorbed into the system. That is when you feel the numbness go away. Probably ok for PD pts.

I think we need to weigh seriously the necessity of any surgery or procedure and understand that there will most likely be problems. Does the benefit outweigh the risk? Diagnostic procedures, like the upper GI, need to be thought of in terms of what would you do if there was a problem? You are dealing with an elderly couple and your FIL has the ultimate say so in your MIL's case. It doesn't sound as if they are going to listen to you but rather go ahead and do what they want. Your weapon is the fact that they will be in a nursing facility if they don't listen to you.

Are they being taken care of by a movement disorder specialist or a neurologist? This is crucial. Cardiologists, orthopaedic surgeons, Internists have a speciality and do not often know much about PD. It is not unusual to see drugs prescribed that should not be given to PD pts. Doesn't mean that they are bad docs.

Hope this helps.

By in-faith On 2009.11.25 07:15
Annwood, this info is very helpful! Thank you so much for looking into this for me. My in-laws are actually relying on me to help them with all these medical issues. However, I have insisted that either my husband or his brother also be present when any major decisions (such as this GI procedure) need to be made.

My MIL does see a neurologist who is a movement disorder specialist. My FIL will also be seeing him. The challenge with my MIL is that she has so many medical issues unrelated to PD.

Thanks for helping me navigate this very confusing world of PD.

By susger8 On 2009.11.25 10:28
We also need to ask ourselves what we would do with the results of invasive diagnostic procedures. Would the result, either way, change the treatment of the person with PD? My dad was found to have blood in his stool, and although it could be from his hemorrhoids, his doctor suggested a colonoscopy. So I asked what treatment he would give an 87-year-old man with late-stage PD if he did turn out to have colon cancer? Because neither my dad nor I had any interest in putting him through chemo, radiation or surgery. If he had colon cancer and it shortened his life, so be it.

On the other hand, sometimes the result rules out another condition, which can be useful, or suggests a course of treatment that is acceptable to the PWP and the family. But I think these questions should be asked.

By dkleinert On 2009.11.27 10:38
Annwood: Thank you again for your great research and advice - thank your son also.


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