Anesthetic management of a patient with amyotrophic lateral sclerosis for transurethral resection of bladder tumor

Thampi, Suma Mary; David, Deepu; Chandy, Tony Thomson; Nandhakumar, Amar

doi:10.4103/0019-5049.111863

Cited by 15 publications

(9 citation statements)

References 12 publications

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“…[ 7 ] Some reports have described successful anesthetic management of ALS patients undergoing elective surgery by using regional anesthesia and general anesthesia without NMBA. [ 8 9 ] However, general anesthesia with NMBA could not be avoided in our case. Postoperative respiratory failure was highly expected in our case because he had neuromuscular disorder with COPD.…”

Section: Discussionmentioning

confidence: 82%

Successful bilevel positive airway pressure therapy in a patient with amyotrophic lateral sclerosis after emergency laparotomy: A case report

et al. 2020

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Section: Discussionmentioning

confidence: 82%

Successful bilevel positive airway pressure therapy in a patient with amyotrophic lateral sclerosis after emergency laparotomy: A case report

et al. 2020

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“…[ 3 ] Aspiration or ventilatory depression can be caused by general anaesthesia due to abnormal response of muscle relaxants whereas spinal anesthesia can exacerbate the preexisting neurological diseases. [ 4 ] Thus, anaesthesia needs modification, short-acting agents must be used to prevent an unpredictable response to muscle relaxants and to ensure quick reversal in a patient of ALS. [ 5 ] The depolarizing neuromuscular blocking drugs may increase rhabdomyolysis and massive hyperkalemia in such patients.…”

mentioning

confidence: 99%

Amyotrophic lateral sclerosis and anaesthetic challenges: Perioperative lignocaine infusion–an aid

2020

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“…Therefore, the preferred anesthetic technique in these patients is TIVA or regional anesthesia. Thampi et al [4] described the use of TIVA with an obturator nerve block in the successful anesthetic management of a patient with ALS for transurethral resection of the prostate. The TAP block targets the myocutaneous nerves to the anterior abdominal wall (T6 to L1).…”

mentioning

confidence: 99%

Transverse abdominis plane block for surgical anesthesia in a patient with flail arm syndrome

Mishra

Govil

Parameswaran

et al. 2020

Korean J Anesthesiol

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Flail arm syndrome (FAS), also known as 'man-in-the-barrel' syndrome or brachial amyotrophic diplegia, is an atypical presentation of amyotrophic lateral sclerosis (ALS). It is differentiated from ALS by lower motor neuron type proximal muscle weakness of only the upper limbs. The lower limbs may show mild upper motor neuron type weakness, but the bulbar and respiratory muscles are not affected. It has a progressive course with a male-to-female ratio of 4 : 1 [1]. FAS is one of the spectra of motor neuron disease (MND) and shares many of the pathophysiological features of MND. MND is a degenerative disease of the spinal cord tracts and leads to respiratory muscle atrophy due to the ongoing, chronic process of denervation and re-innervation of muscles. We describe the anesthetic management of a 50-year-old male (164 cm tall and 54 kg) that had FAS with bilateral proximal upper limb weakness and chronic obstructive respiratory disease. The patient was a chronic smoker. He had been recently diagnosed with an epigastric hernia and was scheduled for a mesh hernioplasty. The patient had gradually progressive and symmetrical weakness of his proximal muscles of both upper limbs, for 2 years, with no wasting or weakness in the distal muscles. His symptoms had worsened over the previous 6 months. There was severe wasting of the bilateral shoulder and arm muscles, with the power grading being 2/5. The patient's neurophysiological assessment was normal. A muscle biopsy suggested neurogenic atrophy. Pulmonary function assessment indicated moderate obstruction on spirometry. The patient was at risk of acute respiratory failure due to his respiratory status and the general aspiration risk of MND patients. Hence, we decided to adopt a transverse abdominis plane (TAP) block as our first choice of anesthesia. If the block failed, we were prepared to administer total intravenous anesthesia (TIVA) with propofol and dexmedetomidine without a muscle relaxant. Bronchodilator nebulization and anti-aspiration prophylaxis were done in the preoperative preparation. Under all aseptic precautions, the patient was given an ultrasound-guided bilateral subcostal TAP block, using 15 ml of 0.5% ropivacaine on either side. The patient was also given mild sedation with dexmedetomidine bolus of 50 μg over 10 minutes, followed by 25 μg/h. The total duration of the procedure was ninety minutes. Intra-operative management was uneventful, and the patient was shifted to the postoperative anesthesia unit with stable hemodynamics and respiratory status. There were no adverse effects on the patient's vitals, respiratory depression, sedation, and muscle weakness observed during the postoperative period. There is a lack of literature in the anesthetic management of patients with FAS. In FAS patients, we have the same anesthetic considerations as those with ALS or MND. Neuromuscular monitoring and the need for postoperative mechanical ventilation must be anticipated where muscle relaxants cannot be avoided [2]. Depolarizing muscle relaxants such as succinylcho...

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Anesthetic management of a patient with amyotrophic lateral sclerosis for transurethral resection of bladder tumor

Cited by 15 publications

References 12 publications

Successful bilevel positive airway pressure therapy in a patient with amyotrophic lateral sclerosis after emergency laparotomy: A case report

Successful bilevel positive airway pressure therapy in a patient with amyotrophic lateral sclerosis after emergency laparotomy: A case report

Amyotrophic lateral sclerosis and anaesthetic challenges: Perioperative lignocaine infusion–an aid

Transverse abdominis plane block for surgical anesthesia in a patient with flail arm syndrome

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