An example of a wood-stiff state after surgery in patients with Parkinson's disease

Patient, female, 69 years old, 156 cm, 56kgThe old fracture of the right femur neck (head type) due to trauma is intended for artificial double-acting semi-hip replacement for the fracture of the right femur neck in the whole hemp downlinkPreviously nohypertension, coronary heart disease,diabetesand other medical history, suffering from Parkinson's disease for 3 years, has been in accordance with the physician's advice oral dopabasille tablets 3 times a day, each time 0.25g, self-described disease control is OKNo family history of genetic disorders and neuropsychiatric disordersroutine laboratory examination situated no obvious abnormalitiesThe patient continued to take dopasy tablets at 8:30 a.m25gPost-entry monitoring of vital signs, BP126/67mmHg, HR72 times/min, RR21 times/min, SpO2 96%Give midazolam 2.0mg, Shufentani 15.0?g, shun aquor ammonium 10.0mg, rely on miede 12mg intravenous injection conventional inductionInduced smooth, intubation smooth, the use of inhalation of heptafluoroetheration, pump injection riffentani, intermittent push-down-type aquku ammonium to maintain anesthesiaoperation began at 10:00 and ended at 11:50, with stable vital signsThe patient was soberly removed from the trachea and fed into the PACU at 12:10After surgery, the formula for mechanical pump vein analgesia (PCIA) is: Shofentani 100 sg plus physiological saline 98 ml a total of 100 ml pump speed of 2 ml/h, not to the load dosePatients at 13:25 appear edging should not, check the body: pulse 118 times / minute, RR20 times / minute, body temperature 36.5 degrees C, blood pressure 123/72mmHg, SpO2 98%, double-to-peer, diameter 0.3 cm, sensitive to light, neck strong, strong limbs, double breathing clear tone, no obvious dry wetdiscontinued PCIA, symptoms are not alleviated, blood gas (pH7.394, PaCO2 36.2mmHg, PaO2 153.5mmHg, Na-139.0mmol/L, K-3.9mmol/L, Ca2-1.102mmol/L, Glu6 .8mmol/L, Lac 1.0mmol/L, Hc31.0%, HCO3 21.6mmol/L, BE-2.88, Hb85.2g/L, SO2 100%, Cl-112.3mmol/L, hemoglobin 15ng/mlurgently asked the neurology, neurosurgery consultation, after looking at the patient pointed out that, in addition to the call should not, neck strong straight, limb muscle tone is gear-like increase, no important positive signs of the nervous system, consider for Parkinson's etiology stress and surgery after the failure to take dopasilk tablets in time to lead to the possibility of exacerbation of symptoms, placed in the nasalstomachtube and nasal feeding dobasilkic tablets 0.25g, continue to observe the change of the diseaseAfter 30min the patient's condition gradually improved, call energy should, to answer the question, can follow the doctor's instructions actionAfter questioning, it was found that he could recall medical staff examinations, consultations, dialogues and treatments, but could not open their eyes, respond, and could not move the whole bodydiscussionParkinson's disease, also known as tremor paralysis, is one of the important concular diseases of the central nervous system, with the loss of central brain black dopamine neurons, significantly reduced levels of striatum dopamine (DA), and the presence of black and blue spots in Lewy small body as its pathological characteristics of neurodegenerative diseasesDobasilla tablets are a combination of l-dopa (L-DOPA) and are still one of the most commonly used drugs for Parkinson's diseaseWhen the dopabarb tablets are suddenly discontinued, the left-handed dopa rapidly drops, producing receptor blocking performance and the appearance of conical external symptomscommon symptoms and signs of levodopa withdrawal are the aggravation of Parkinson's disease symptoms, with significant increased muscle tone, elevated body temperature, consciousness disorders, significant serum creatine kinase elevation and autonomic nerve dysfunctionIn this case, the patient's appearance in the short term after surgery is characterized by increased muscle tone, severe neck, unable to respond to adverse postoperative reactions as the main manifestation, the need to identifydiagnosisis intracranial bleeding, infection and malignant hypertherance Since the patient's surgical site is not involved in the intracranial and vertebral tubes, and no fever performance can be excluded from the intracranial infection The patient's circulatory circulation is stable during surgery and the operation does not involve intracranial, which can be ruled out for intracranial bleeding the patient after the use of inhaled anesthetic drugs in the whole hemp appeared muscle tension increase, heart rate increase, the presence of malignant hyperthermia causes and manifestations, but the patient's body temperature is normal, no hypercarbonemia and hyperkalemia, hemoglobin no significant increase, not consistent with malignant hyperthermia, not in accordance with malignant hyperthermia treatment, but need to closely observe the patient's condition changes Combined with patients with Parkinson's disease, regular use of dopasyse tablets for 3 years, from the preoperative use of dopasillin tablets 4h55min after the emergence of increased muscle tone, the decline of the concentration of left-handed dopa is greater, given dopasille tablets after the patient's symptom relief can be confirmed The withdrawal reaction of Patients with Parkinson's disease is common lying after surgery as a condition of increased body temperature, larynx spasms, postoperative delirium, consciousness disorders, difficulty swallowing, etc for Patients with Parkinson's disease with increased muscle tone after surgery, unable to respond need to consider the sharp decline in the concentration of l-dopa and timely treatment of l-dopa The reduction of the concentration of lvocyclopal dopa during perioperative period is prone to nerve dysfunction, confusion, drowsiness, inability to move autonomously and other adverse reactions, increase dispensary lung infection and other related complications, is not conducive to the recovery of patients, increase mortality, so it is very important for Parkinson's patients to maintain the stability of the perinatal left-handeddopa level Lvodopa by small intestine absorption, half-life of 1 to 3h, short time, before surgery left-handed dopa use time should be close to the start time of anesthesia, can be given to the left-handed dopa before anesthesia 30min, for a long time surgery, can consider placement gastric tube in the operation to supplement the left-handed dopa, after surgery should be used as soon as possible For patients with preoperative surgery that combine Parkinson's disease, we can ask a neurology consultation to jointly develop a drug treatment plan for perioperative anti-Parkinson disease, in order to maintain the effective drug concentration of lvocyclopaine in the plasma during surgery and reduce the occurrence of related complications