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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.

Potential drug interactions are described and recommendations are made about suitable anaesthetic techniques.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.This leads to the activation of proteases, endonucleases, phospholipases, and nitric oxide synthetase, which in turn generate reactive nitric oxide free radicals, release of iron from ferritin, and lipid peroxidation.57 Neurotrophic factors are important in neuronal function and inadequate concentrations cause apoptotic cell death.Both glial‐derived neurotrophic factor (GDNF) and brain‐derived neurotrophic factor (BDNF) are potent protective and regenerative agents, and animal studies have suggested that these may be deficient in Parkinson’s disease leading to degeneration of dopaminergic cells.60 Finally, immune factors may also contribute to neuronal cell loss.

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