Propofol beyond use dating

The clinical features are described in detail and recent advances in medical management are highlighted.Controversies surrounding the use of the newer drugs and possible advances in neurosurgical interventions are discussed.Drugs used in anaesthesia may interact with anti‐parkinsonian medication and there is controversy about the optimal anaesthetic management of patients with Parkinson’s disease.Parkinson’s disease occurs world wide, affecting all ethnic groups, with a very slight male preponderance.139 The prevalence increases exponentially between 65 and 90 yr; approximately 0.3% of the general population and 3% of people over 65 yr have it.76 The EUROPARKINSON study found an overall prevalence of 2.3% for parkinsonism and 1.6% for Parkinson’s disease in a survey of 14 636 participants aged over 65 yr in five European countries.109 As many as 24% of the subjects with Parkinson’s disease were newly diagnosed at the time of the study.

The disease was first formally described during the Industrial Revolution, suggesting that exogenous toxins may have a causative role, but descriptions of conditions resembling Parkinson’s disease are found in literature dating back thousands of years BC.

Hence, the internal globus pallidus is common to both pathways (Fig.

1).58 The nigrostriatal pathway projects from the substantia nigra pars compacta to the striatum, where it makes two kinds of synapses on the projection neurones.

MPTP toxicity is due to inhibition of complex‐1 of the mitochondrial electron transport chain, leading to lack of ATP and cell death.

In Parkinson’s disease, there is a 30–40% decrease in complex‐1 activity in the substantia nigra pars compacta which may contribute to energy failure and hence predispose the pars compacta to toxic insults and increase its susceptibility to cell death.68 Oxidative stress may be caused by an increase in the number of reactive species including hydrogen ions, superoxide, peroxyl radicals, nitric oxide, and hydroxyl radicals.

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