Abstract
BackgroundParkinson’s disease (PD) patients often suffer from cardiac sympathetic denervation, a hallmark of which is orthostatic hypotension. Denervation supersensitivity to sympathomimetic drugs is also seen in such patients, and this phenomenon is important and can be sometimes dangerous.Case presentationA 65-year-old male underwent gastrojejunostomy. The patient had severe PD and did not exhibit metaiodobenzylguanidine (MIBG) accumulation in his heart, which was indicative of cardiac sympathetic nerve denervation. When 8 mg of ephedrine was administered intravenously, an unexpectedly large increase in blood pressure was observed. The phenomenon recurred when 4 mg of ephedrine was administered again, and nicardipine was required to suppress the patient’s blood pressure.ConclusionsDenervation supersensitivity is not as well recognized as other complications seen in PD patients, but anesthesiologists should be aware of it because sympathomimetic drugs can have excessively strong effects in patients with the condition.
Highlights
Parkinson’s disease (PD) patients often suffer from cardiac sympathetic denervation, a hallmark of which is orthostatic hypotension
Denervation supersensitivity is not as well recognized as other complications seen in PD patients, but anesthesiologists should be aware of it because sympathomimetic drugs can have excessively strong effects in patients with the condition
Eight milligrams of ephedrine was administered intravenously when the patient’s blood pressure decreased, and an unexpectedly large increase in blood pressure was observed. This phenomenon recurred when 4 mg of ephedrine was administered again, but Discussion We reported a case in which ephedrine unexpectedly caused a marked increase in blood pressure in a patient with PD, whose cardiac sympathetic nerves were almost completely denervated
Summary
We encountered a case in which ephedrine induced an unusually large increase in blood pressure in a patient with PD, whose cardiac sympathetic nerves were almost completely denervated. We need to know that PD patients often suffer from cardiac sympathetic nerve denervation and cardiac denervation supersensitivity to sympathomimetic drugs. Authors’ contributions TS collected the data and wrote the manuscript. AK collected the data and helped TS with the preparation of the manuscript. KU, TU, MF, and TI performed the patient’s anesthetic management and helped TS with the preparation of the manuscript. SN helped TS write the manuscript and corrected English. All authors read and approved the final manuscript. Ethics approval and consent to participate Not applicable. Consent for publication The written informed consent for publication was obtained from the patient. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations
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