Epidural Anesthesia for Patients with Amyotrophic Lateral Sclerosis

Kochi, Tetsuo; Oka, Tatsuhiro; Mizuguchi, Tadanobu

doi:10.1213/00000539-198903000-00046

Cited by 42 publications

(15 citation statements)

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“…94 The existing evidence, albeit limited, has not supported the fear that neuraxial or peripheral blockade will exacerbate preexisting symptoms in ALS patients. 65,[95][96][97][98][99] However, given the potential for worsening respiratory failure after general anesthesia because of the use of muscle relaxants and opioid medications, the ability to avoid airway manipulation may be considered a benefit within this high-risk patient population. Regardless of the anesthetic technique, the possibility of postoperative respiratory or neurologic deterioration is quite high in patients with ALS.…”

Section: Amyotrophic Lateral Sclerosismentioning

confidence: 99%

Regional Anesthesia in Patients With Preexisting Neurologic Disease

Kopp

Jacob

Hebl

2015

Regional Anesthesia and Pain Medicine

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Since publication of initial recommendations in 2008, there is limited new information regarding the performance of regional anesthesia in patients with preexisting neurologic diseases. However, the strength of evidence has increased since 2008 regarding (1) the concern that diabetic nerves are more sensitive to local anesthetics and perhaps more susceptible to injury and (2) the concern that performing neuraxial anesthesia and analgesia in patients with preexisting spinal canal pathology may increase the risk of new or worsening neurologic symptoms. This increased evidence reinforces our initial recommendations. In addition, since the initial recommendations in 2008, the concept of postsurgical inflammatory neuropathy has been described and is potentially a contributor to postoperative neurologic dysfunction.

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Section: Amyotrophic Lateral Sclerosismentioning

confidence: 99%

Regional Anesthesia in Patients With Preexisting Neurologic Disease

Kopp

Jacob

Hebl

2015

Regional Anesthesia and Pain Medicine

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“…In a previous report, epidural anesthesia appear red to be useful and safe for patients with ALS undergoing lower-abdominal or lower-extremity surgery [12]. However, careful postoperative management is important, because, in ALS patients, mild pulmonary dysfunction may occur without hypoxemia or any clinical symptoms, regardless of the anesthesia method used [13].…”

Section: Discussionmentioning

confidence: 96%

Total intravenous anesthesia without muscle relaxant in a patient with amyotrophic lateral sclerosis

Lee

Kim

et al. 2008

J Anesth

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A 63-year-old woman with amyotrophic lateral sclerosis (ALS) was scheduled for open reduction and internal fixation of the right tibia. Total intravenous anesthesia using propofol and remifentanil without muscle relaxant was selected as the anesthetic method, in order to avoid the possible occurrence of ventilatory depression due to abnormal responses to muscle relaxants and exacerbation of the motor neuron disease. After standard and neuromuscular monitoring devices were applied, anesthesia was induced and maintained with target controlled infusion of propofol and remifentanil in the range of 2.5-5.0 microg x ml(-1) and 2.5-5.0 ng x ml(-1), respectively. To avoid delayed neuromuscular recovery, we did not use any muscle relaxant at all. Intubation was successful and there were no remarkable events during anesthesia, except for three brief hypotensive events; there was no exacerbation of ALS itself during or after the anesthesia. She was discharged on postoperative day 3, without any discomfort.

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“…However, there are now reports of regional anaesthesia being successfully used in patients with multiple sclerosis, 10 syringomyelia, 11 Friedrich's ataxia, 12 paraplegia 13 and amyotrophic lateral sclerosis. 14 Within obstetric anaesthesia regional techniques are being performed in increasing numbers as the number of general anaesthetics performed declines. The risks of general anaesthesia in the obstetric population are Spinal anaesthesia and hereditary spastic paraplegia 255 well documented and these extend into the immediate post-partum period.…”

Section: Discussionmentioning

confidence: 99%