Rigidity and pulmonary edema after Innovar in a patient on Levodopa therapy: report of a case

Interactions of CNS Drugs: Psychotherapeutic Agents—The Antipsychotic Drugs

Aspects of the pharmacology of the phenothiazine antipsychotic agents pertinent to possible interactions are reviewed. Pharmacokinetic interactions of possible clinical importance are the interference with the absorption of the phenothiazines by antacids, reversal of the hypotensive effect of guanethidine by psychotropic drugs, blockade of the effects of levodopa in Parkinson's disease, and stimulation of phenothiazine-metabolizing enzymes by phenobarbital. Pharmacologically, phenothiazines may potentiate certain depressant effects of other CNS depressants or add to the anticholinergic side effects of a number of other drugs. The phenothiazines appear to antagonize both the CNS stimulant and the anorexic effects of amphetamines and related substances. Other reactions of possible concern are the phenothiazine-induced hypoglycemia, the relationship of lithium toxicity to sodium intake, and the number of false positive pregnancy tests in patients on phenothiazine therapy.

Parkinson's disease and deep brain stimulator placement

Deep brain stimulation (DBS) has added to the comfort and quality of life for an increasing number of Parkinson's disease (PD) patients. The anesthesiologist needs to understand the pathophysiology of the disease, the surgical procedure, and its postoperative implications to most effectively manage these patients. This article examines the role of the anesthesiologist in the pre- and perioperative management of patients undergoing DBS procedures. In terms of the general anesthetic management of PD patients, it is clear that no simple anesthetic regimen exists. Anesthesiologists can provide the best care through preoperative assessment, maintenance of PD drug therapy, and avoidance of known precipitating agents.