A remifentanil/ketamine sedation in surgical cancer patients having severe Parkinson's disease: two case reports.

Symptoms of Parkinson's disease are related to a progressive loss of substancia nigra's dopaminergic neurons in addition to persistent activation of N-methyl-D-aspartate receptors. In specific situations such as sedation for minor surgery, tremor and dyskinesia can be very disabling. We report the beneficial effect of the combination of remifentanil (target-controlled infusion mode) and ketamine (boluses IV) to control dyskinesia and tremor for two elderly patients with Parkinson's disease. The patients were scheduled for elective oncological plastic surgery under sedation, for which dyskinesia and tremor needed to be quickly abolished to permit surgery. Both procedures were completed with this drug combination resulting with no major side effects.