Anesthetic considerations for laparoscopy for rectal cancer in patient with amyotrophic lateral sclerosis: A case report

Kim, Bo Ra; Lee, Young Bok; Kim, Su Jin; Kim, Young Wan

doi:10.1016/j.egja.2018.09.002

Cited by 3 publications

(5 citation statements)

References 6 publications

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“…Specific potential concerns have been raised over increased sensitivity and prolonged effects of non-depolarising neuromuscular blocking drugs in ALS. 107 In ALS, sensitivities to rocuronium, 28,108 vecuronium 109 and cisatracurium 110 have been reported, and augment extrapolations from other neuromuscular diseases. 103 Avoiding neuromuscular blocking drugs if possible is recommended.…”

Section: Intraoperative Considerationsmentioning

confidence: 52%

“…Patients with ALS can present for any form of elective surgery and for time-dependent operations such as emergency surgery, 22–25 trauma 26,27 and cancer surgery. 28–32 ALS can coincide with pregnancy 33–43 and increased respiratory requirements combined with ventilatory weakness can cause rapid decompensation as pregnancy progresses. Vaginal delivery is possible as uterine dynamics are unaffected.…”

Section: Treatmentsmentioning

confidence: 99%

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Perioperative management of patients with amyotrophic lateral sclerosis: A narrative review

Paul

Wright

Palmer

et al. 2022

Anaesth Intensive Care

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Amyotrophic lateral sclerosis, or motor neuron disease, is an uncommon progressive neurological disorder. Professionals working in the perioperative field may encounter patients with amyotrophic lateral sclerosis only rarely. The relevant published literature on amyotrophic lateral sclerosis is broad in scope, but a contemporary review focused on the perioperative period is absent. This structured narrative review seeks to provide a summary of the contemporary management of patients and then focuses on eliciting if there are perioperative management considerations specific to amyotrophic lateral sclerosis that can be optimised. A comprehensive structured narrative literature review, including grey literature searching, indicated worsening ventilatory failure is of prime concern but that patients may present with a broad range of neurological symptoms, and that cardiovascular and cognitive dysfunction specific to amyotrophic lateral sclerosis may exist and be occult. Exacerbation of neuromuscular weakness during the perioperative period is multifaceted and requires the application of a high standard of the core principles of surgical and anaesthetic management of neuromuscular disease. Standard perioperative approaches require rigorous attention and potential exists for significant alteration. There is a potential high risk of postoperative increased morbidity from neurological decline and mortality from pulmonary complications. A meticulous approach to planning preoperative assessment, shared decision-making, intraoperative and postoperative care is required.

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Section: Intraoperative Considerationsmentioning

confidence: 52%

Section: Treatmentsmentioning

confidence: 99%

Perioperative management of patients with amyotrophic lateral sclerosis: A narrative review

Paul

Wright

Palmer

et al. 2022

Anaesth Intensive Care

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“…A literature search on this topic only yields a few case reports and case series. 3,5,[7][8][9][10][11][12] Hoeper et al 5 published a case series of 89 procedures (primarily gastrostomy tube placement and bone marrow biopsies) comparing outcomes with the use of GA versus sedation. The majority of serious complications resulted from GA, and this was especially pronounced in patients with more advanced disease.…”

Section: Discussionmentioning

confidence: 99%

Combined Spinal-Epidural for Loop Ileostomy in a Patient With End-Stage Amyotrophic Lateral Sclerosis: A Case Report

Roth

Harris

2022

A&A Practice

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Anesthesia can be a challenge for patients with amyotrophic lateral sclerosis (ALS). This progressive neurological disease is associated with a high risk of aspiration and postoperative ventilatory failure. Our patient was a 72-year-old man with ALS, quadriplegia, bulbar symptoms, dysphagia, and dysarthria who underwent palliative exploratory laparotomy and loop ileostomy creation. He received a single-shot spinal anesthetic at L4-L5 and a thoracic T11-12 epidural. He tolerated the procedure well with no perioperative pulmonary complications or worsening of his ALS. To reduce the risks of general anesthesia, we chose a neuraxial approach.

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“…In case of an ALS patient with rectal cancer, laparoscopic low anterior resection with diverting loop ileostomy and total abdominal hysterectomy were performed under general anesthesia using the combination of propofol and rocuronium for induction and the regime of sevoflurane and remifentanil for maintenance [34]. After the surgery, glycopyrrolate and pyridostigmine bromide were used to reverse the muscle relaxant effects of rocuronium [34]. Postoperative use of fentanyl controlling analgesia in the patient consisted of intermittent low doses within 48 hours, and the patient recovered uneventfully [34].…”

Section: Postoperative Care For Als Patientsmentioning

confidence: 99%

“…After the surgery, glycopyrrolate and pyridostigmine bromide were used to reverse the muscle relaxant effects of rocuronium [34]. Postoperative use of fentanyl controlling analgesia in the patient consisted of intermittent low doses within 48 hours, and the patient recovered uneventfully [34]. The use of fentanyl should be cautioned against as it causes respiratory muscle rigidity and subsequent respiratory dysfunction in ALS patients.…”

Section: Postoperative Care For Als Patientsmentioning

confidence: 99%

Motor Neuron Disease and Delicate Anesthesia Choices – Anesthesia for Motor Neuron Disease Patients

Wenqiao Yang

2024

Motor Neurons - New Insights

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Motor neuron diseases (MNDs), two major types of which are amyotrophic lateral sclerosis (ALS) and spinal muscular atrophy (SMA), are caused by upper and/or lower motor neuron degeneration and death. They manifest with progressive skeletal muscle atrophy. Most ALS cases are idiopathic, whereas the cause of SMA is genetic. There is no cure for MNDs and anesthetic management is challenging due to patients’ respiratory dysfunction, abnormal response to muscle relaxants, and high risk of aspiration. General guidelines for this purpose state that intravenous administration of propofol and remifentanil are preferred. Muscle relaxants should be used sparingly due to their causing ventilatory depression, and depolarizing neuromuscular blockers should be avoided entirely for patients’ risk of hyperkalemia. This chapter discusses the etiology of MNDs, their clinical features, disease prognosis, palliative treatments, necessary surgical procedures, and preoperative and postoperative anesthetic management. It covers ALS, SMA, and other less common MNDs.

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Anesthetic considerations for laparoscopy for rectal cancer in patient with amyotrophic lateral sclerosis: A case report

Cited by 3 publications

References 6 publications

Perioperative management of patients with amyotrophic lateral sclerosis: A narrative review

Perioperative management of patients with amyotrophic lateral sclerosis: A narrative review

Combined Spinal-Epidural for Loop Ileostomy in a Patient With End-Stage Amyotrophic Lateral Sclerosis: A Case Report

Motor Neuron Disease and Delicate Anesthesia Choices – Anesthesia for Motor Neuron Disease Patients

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