Q: 72 years old male with a history of Parkinson's disease is extubated after his community-acquired pneumonia. The patient immediately developed stridor on extubation and required re-intubation. What makes Parkinson's disease a high risk of extubation?
Answer: Abnormal vocal cord closure
Patients with Parkinson's disease develop abnormal vocal cord closure as their disease progresses, causing dysphonia or hypophonia. This is due either to vocal cord rigidity or to excessive laxity. This gets compounded by multiple system atrophy. To make things further complicated, the hold of antiparkinsonian medications for any reason, like surgery or prolonged illness, makes this susceptibility worse.
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References:
1. Gan EC, Lau DP, Cheah KL. Stridor in Parkinson's disease: a case of 'dry drowning'? J Laryngol Otol 2010; 124:668.
2. Vincken WG, Gauthier SG, Dollfuss RE, et al. Involvement of upper-airway muscles in extrapyramidal disorders. A cause of airflow limitation. N Engl J Med 1984; 311:438.
3. Easdown LJ, Tessler MJ, Minuk J. Upper airway involvement in Parkinson's disease resulting in postoperative respiratory failure. Can J Anaesth 1995; 42:344.
4. Liu EH, Choy J, Dhara SS. Persistent perioperative laryngospasm in a patient with Parkinson's disease. Can J Anaesth 1998; 45:495.
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