Respiratory arrest triggered by peripheral venous line insertion during the wearing-off phenomenon in a patient with Parkinson's disease: A case report

Parkinson's disease is a common neurodegenerative disorder that often affects airway and respiratory function. Although upper airway obstruction following general anesthesia is well documented, we report a rare case of respiratory arrest that occurred prior to anesthesia induction. A 74-year-old woman with Parkinson's disease, receiving levodopa/carbidopa and rotigotine, was scheduled to undergo left mastectomy. Her medications were continued until just before anesthesia. Upon entering the operating room, she appeared to be experiencing the wearing-off phenomenon. Insertion of a peripheral intravenous line exacerbated her rigidity and precipitated respiratory arrest, rendering mask ventilation impossible. Rocuronium and remimazolam enabled effective mask ventilation, although her percutaneous oxygen saturation dropped to 49 %. This case highlights the importance of heightened vigilance in Parkinson's disease patients during the wearing-off phenomenon. Anesthesiologists play a central role in the perioperative management of Parkinson's disease patients and must ensure appropriate medication continuity and preparedness for sudden symptom exacerbation.