Spinal anesthetic management for discectomy in a patient with amyotrophic lateral sclerosis -A case report-

Abstract

Amyotrophic lateral sclerosis (ALS), also referred to as Lou Gehrig's disease, is a degenerative disorder of motor neuron system of the spinal cord and the cortical neuron. Patients with ALS present a unique challenge to the anesthesiologist. Respiratory muscle weakness, for instance, can result in trouble with proper breathing after general anesthesia. We report a case of spinal anesthesia for discectomy in a patient with ALS.

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

“…ALS causes the degeneration of upper and lower motor neurons. [ 2 ] leading to muscle atrophy, muscle spasticity, and muscle weakness. [ 1 ] In the majority of ALS patients, the respiratory failure and death are mainly caused due to atrophy and weakness of the respiratory muscles.…”

“…[ 1 ] In the majority of ALS patients, the respiratory failure and death are mainly caused due to atrophy and weakness of the respiratory muscles. [ 2 ] limiting the survival to 2-5 years after the onset of the disease. [ 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.…”

Comment on "Anaesthetic management of a patient with amyotrophic lateral sclerosis for transurethral resection of bladder tumour"

“…[234] In an innovative study, Kitoh et al . administered epidural block associated with the blockade of lumbar sympathetic ganglia for the treatment of ALS in a patient and observed improvement of the symptoms of the affected lower limb.…”

“… It is not possible to state that neuraxial anaesthesia exacerbates the disease and if it does, the mechanism is unknown,[ 2 ] Needle trauma may probably incite neurological sequel in ALS patients as well as in healthy patients, Evidence has demonstrated that spinal and epidural blocks seem to be safe in these patients, since they avoid manipulation of the airway and respiratory complications. [ 2 3 4 ] In an innovative study, Kitoh et al . administered epidural block associated with the blockade of lumbar sympathetic ganglia for the treatment of ALS in a patient and observed improvement of the symptoms of the affected lower limb.…”

“…Evidence has demonstrated that spinal and epidural blocks seem to be safe in these patients, since they avoid manipulation of the airway and respiratory complications. [ 2 3 4 ] In an innovative study, Kitoh et al . administered epidural block associated with the blockade of lumbar sympathetic ganglia for the treatment of ALS in a patient and observed improvement of the symptoms of the affected lower limb.…”