Perioperative Use of Apomorphine in Parkinson's Disease

Perioperative complications and worsening of motor symptoms are common in patients with Parkinson's disease (PD). Adequate treatment with dopaminergic drugs is the best prevention of these problems. Soluble levodopa should be given in PD patients at risk, and the application via a nasogastric tube is often needed after surgery. Moreover, the highly potent dopamine agonist apomorphine can be given subcutaneously ideally by using a minipump for continuous drug infusion. Apomorphine is also suitable to bridge the iatrogenic levodopa withdrawal period in advanced PD patients undergoing surgery for deep brain stimulation in the awake state.