Going into hospital for surgery

Before your operation, you’ll be given an anaesthetic. This is a medication that stops your body from feeling pain. It will be given by an anaesthetist – a doctor who specialises in anaesthetics and pain management.

Your surgery may be done under general anaesthetic (when you’re asleep), or under local anaesthetic (when you’re awake). Local anaesthetics are given to numb a small part of the body, so you don’t feel pain in that area. Regional anaesthetics are a type of local anaesthetic given to numb a larger part of the body during surgery.

You’ll usually meet your anaesthetist on the ward before your surgery. It‘s very important that your anaesthetist knows you have Parkinson’s and what medication you take for it. Some anaesthetics may make Parkinson’s symptoms worse or interfere with Parkinson’s medication. The anaesthetist can plan your care appropriately around this.

When you meet your anaesthetist, they will:

• go through your answers to the pre-admission questions
• discuss your Parkinson’s symptoms and how they may affect you during surgery
• explain any risks or side effects of the drugs they give
  you might have

Can I keep taking my Parkinson's medication right up until the time of surgery?

It’s important that you can keep taking your Parkinson’s medication as close to your surgery as possible. You should also take it soon as possible after the operation.

You may be asked not to eat or drink for a period of time before the operation (‘nil by mouth’). But you’re usually allowed to keep taking your medication with a few sips of water during this time. Your anaesthetist will discuss plans for this with you before your operation.

If you have Parkinson’s, your surgery may be put at the start of the day. This can mean that the risk of the surgery being cancelled is lower. For example, if other procedures in the hospital take longer than expected.

Organising your medication routine is also easier if you know what time your surgery will be in advance.

Medication may be given during surgery if your operation is taking longer than planned and there is a risk of missing a dose.

Levodopa

If you usually take levodopa, it may be possible to give you your dose using a tube that goes into your stomach. You should discuss this with your anaesthetist.

Dopamine agonists

If you normally take oral dopamine agonists and are nil by mouth due to surgery, you may be switched to a dopamine agonist patch. The patch is applied to your skin and, once in place, lasts for 24 hours.

You may also be changed to a patch if medication needs to be given during surgery. This will be applied before your operation.

The patch will deliver the same dose of medication as you’d normally take orally. Your specialist can advise your surgical team about this.

Apomorphine

Depending on the procedure, you may not be able to take your usual oral medication after surgery. But it may be possible to use different drugs, such as apomorphine. It's a strong dopamine agonist and can be taken by intermittent injection, or via infusion using a pump.

Your healthcare team should discuss the option of apomorphine after surgery with you before you go into hospital. Your Parkinson’s specialist will also be involved in the decision.

Low blood pressure

You may experience low blood pressure because of your Parkinson’s. You should tell your anaesthetist if this affects you. 

During some types of surgery, anaesthetic can cause blood pressure to drop. This can include surgeries that aren’t heart related that are done under general anaesthetic.

Involuntary movements (dyskinesia)

Dyskinesia are involuntary movements of the arms, legs, hands, or other body parts, that can’t be controlled. It’s a side effect of some Parkinson’s drugs when they’ve been used for a long time.

Involuntary movements may affect procedures where you need to keep still. This includes x-rays, scans or radiotherapy. Radiographers usually have ways to help stop this, such as using foam wedges. These can help to support your body, or body part, and hold it in place while you’re being examined. But it’s still important to talk to your health professional before any procedure as stress may increase motor fluctuations and involuntary movements.

You may need to have a general anaesthetic, or be sedated (given drugs to help you relax) so you’re able to keep still.

Saliva control and swallowing problems

Some people with Parkinson’s have problems controlling their saliva. This can lead to drooling or dribbling.

If you experience these symptoms and are having a general anaesthetic, you may need to have a tube put down your throat to help you breathe. This allows the anaesthetist to make sure your airway stays clear during surgery.

Speak to your health professional if you have any concerns about saliva control or swallowing problems before you have your surgery.