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Li Y, Hu Q, Wang Q, Liu T, Gao M. Real-time ultrasound-guided sacral plexus block combined with mild sedation for hemorrhoidectomy and hemorrhoidal artery ligation in a patient with amyotrophic lateral sclerosis: a case report. J Med Case Rep 2024; 18:205. [PMID: 38654338 PMCID: PMC11041001 DOI: 10.1186/s13256-024-04493-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/06/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Patients with amyotrophic lateral sclerosis present perioperative challenges for clinical anesthesiologists for anesthesia-associated complications. CASE PRESENTATION A 54-year-old Han woman with a 2-year history of amyotrophic lateral sclerosis was scheduled for hemorrhoidectomy and hemorrhoidal artery ligation. We performed real-time ultrasound-guided sacral plexus block with dexmedetomidine under standard monitoring. The anesthesia method met the surgical demands and avoided respiratory complications during the procedures. There was no neurological deterioration after the surgery and 3 months after, the patient was discharged. CONCLUSIONS Real-time ultrasound-guided sacral plexus block combined with mild sedation may be an effective and safe technique in patients with amyotrophic lateral sclerosis undergoing hemorrhoidectomy and hemorrhoidal artery ligation.
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Affiliation(s)
- Yan Li
- Department of Anesthesiology, Guangyuan Central Hospital, Guangyuan, 628000, China.
| | - Qianhui Hu
- Department of Anesthesiology, Guangyuan Central Hospital, Guangyuan, 628000, China
| | - Qian Wang
- Department of Anesthesiology, Guangyuan Central Hospital, Guangyuan, 628000, China
| | - Taotao Liu
- Department of Anesthesiology, Guangyuan Central Hospital, Guangyuan, 628000, China
| | - Min Gao
- Department of Anesthesiology, Guangyuan Central Hospital, Guangyuan, 628000, China
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2
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Roth AF, Harris MJ. Combined Spinal-Epidural for Loop Ileostomy in a Patient With End-Stage Amyotrophic Lateral Sclerosis: A Case Report. A A Pract 2022; 16:e01588. [DOI: 10.1213/xaa.0000000000001588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Nishihara N, Tachibana S, Ikeshima M, Ino A, Yamakage M. Remimazolam enabled safe anesthetic management during tracheostomy in a patient with amyotrophic lateral sclerosis: a case report. JA Clin Rep 2022; 8:25. [PMID: 35347529 PMCID: PMC8960499 DOI: 10.1186/s40981-022-00514-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/05/2022] [Accepted: 03/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background Amyotrophic lateral sclerosis (ALS) is known to cause generalized muscle atrophy and respiratory complications. Anesthetic agents and methods for patients with ALS are extremely important because they critically influence postoperative outcomes. In this clinical case, we mainly used remimazolam for safe anesthesia management. Case presentation A 66-year-old man had a gradual onset of numbness and weakness in his extremities over 2 years. He was diagnosed with ALS after the appearance of dysarthria and restrictive ventilation disorder. Due to the rapid progression of respiratory dysfunction, the patient was placed on artificial respiration, and a tracheostomy was planned. General anesthesia was induced with remimazolam (6 mg/kg/h) and remifentanil (0.5 μg/kg/min). Tracheal intubation was performed without muscle relaxants, followed by total intravenous anesthesia (TIVA) with continuous administration of remimazolam 0.8–1.2 mg/kg/h and remifentanil 0.3–0.5 μg/kg/min. At the end of the surgery, the anesthetic effect of remimazolam was reversed with 0.4 mg of flumazenil. The patient was discharged from the operating room with stable breathing, and changes to preoperative ventilator settings were not necessary. Conclusions We safely performed tracheostomy for a patient with ALS using remimazolam during general anesthesia.
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Affiliation(s)
- Noriaki Nishihara
- Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Shunsuke Tachibana
- Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Mariko Ikeshima
- Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Ayumi Ino
- Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Michiaki Yamakage
- Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
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Brylev L, Fominykh V, Chernenkaia V, Chernenkiy I, Gorbachev K, Ataulina A, Izvekov A, Monakhov M, Olenichev A, Orlov S, Turin I, Loginov M, Rautbart S, Baymukanov A, Parshikov V, Demeshonok V, Yakovlev A, Druzhkova T, Guekht A, Gulyaeva N. Stress load and neurodegeneration after gastrostomy tube placement in amyotrophic lateral sclerosis patients. Metab Brain Dis 2021; 36:2473-2482. [PMID: 34559375 DOI: 10.1007/s11011-021-00837-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 09/02/2021] [Indexed: 11/29/2022]
Abstract
Dysphagia and progressive swallowing problems due to motoneuron death is one of amyotrophic lateral sclerosis (ALS) symptoms. Malnutrition and body weight loss result in immunological disturbances, fatigability and increase risk of secondary complications in ALS patients, percutaneous endoscopic gastrostomy tube (PEG) placement representing a well-recognized method for malnutrition correction and potentially increasing life expectancy. However, despite nutritional correction, occasional rapid neurological deterioration may develop after PEG placement. We have hypothesized that this decline can be a result of exteroceptive stress during PEG placement and promote neurodegeneration in ALS patients. Intravenous sedation may decrease stress during invasive procedures and it is safe during PEG placement in ALS patients. The aim of the study was comparing different PEG placement protocols of anesthesia (local anesthesia or local anesthesia plus intravenous sedation) in ALS from perspectives of stress load and neurological deterioration profile. During 1.5 years 94 ALS patients were admitted; gastrostomy was performed in 79 patients. After screening according to inclusion and exclusion criteria, 30 patients were included in the prospective consecutive study. All patients were divided in two groups, with local anesthesia and with combination of local anesthesia and intravenous sedation. Routine biochemical indices, neurodegeneration and stress markers were measured. The age of ALS patients was 61 ± 10 years; 20 patients were included at stage 4A and 10 at stage 4B (King's College staging). PEG was placed at average14 months after the diagnosis and 2.2 years after first symptoms. Mean ALS Functional Rating Scale-Revised was 27.8, mean forced vital capacity of lung 46.3% (19-91%). After one year of observation only 8 patients survived. Mean life duration after PEG was 5 months (5 days-20 months). Comparison of two PEG placement protocols did not reveal differences in survival time, stress load and inflammation level. Higher saliva cortisol levels, serum cortisol, glucose, C-reactive protein and interleukin-6 were detected after PEG placement, confirming considerable stress response. PEG is a stressful factor for ALS patients, PEG placement representing a natural model of exteroceptive stress. Stress response was detected as increased cortisol, C-reactive protein, interleukin-6, and glucose levels. Intravenous sedation did not increase the risk of PEG placement procedure, however, sedation protocol did not affect stress load.
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Affiliation(s)
- L Brylev
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
- Institute of Higher Nervous Activity and Neurophysiology, Moscow, Russia
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
- "Live Now" Charity Foundation for supporting people with ALS and other neuromuscular disorders, Moscow, Russia
| | - V Fominykh
- Bujanov Moscow City Clinical Hospital, Moscow, Russia.
- Institute of Higher Nervous Activity and Neurophysiology, Moscow, Russia.
| | - V Chernenkaia
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | - I Chernenkiy
- Bauman Moscow State Technical University, Moscow, Russia
| | - K Gorbachev
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | - A Ataulina
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | - A Izvekov
- Mukhin Moscow City Clinical Hospital, Moscow, Russia
| | - M Monakhov
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | - A Olenichev
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | - S Orlov
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | - I Turin
- Moscow City Clinical Hospital №40, Moscow, Russia
| | - M Loginov
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | - S Rautbart
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | - A Baymukanov
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | - V Parshikov
- "Live Now" Charity Foundation for supporting people with ALS and other neuromuscular disorders, Moscow, Russia
| | - V Demeshonok
- "Live Now" Charity Foundation for supporting people with ALS and other neuromuscular disorders, Moscow, Russia
| | - A Yakovlev
- Institute of Higher Nervous Activity and Neurophysiology, Moscow, Russia
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - T Druzhkova
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - A Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - N Gulyaeva
- Institute of Higher Nervous Activity and Neurophysiology, Moscow, Russia
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
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Larson AR, Chen JX, Holman A, Sullivan S, Williams P, Nicholson K, Lin DT, Kiyota Y, Richmon JD. Immediate postoperative non-invasive positive pressure ventilation following midface microvascular free flap reconstruction. Cancer Rep (Hoboken) 2021; 5:e1518. [PMID: 34704400 PMCID: PMC9327656 DOI: 10.1002/cnr2.1518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/04/2021] [Accepted: 07/09/2021] [Indexed: 11/09/2022] Open
Abstract
Background There is a rare need for postoperative non‐invasive positive pressure ventilation (NIPPV) following microvascular reconstruction of the head and neck. In midface reconstruction, the free flap vascular pedicle is especially vulnerable to the compressive forces of positive pressure delivery. Case A 60 year old female with Amyotrophic Lateral Sclerosis (ALS) presented with squamous cell carcinoma of the anterior maxilla, for which she underwent infrastructure maxillectomy and fibula free flap reconstruction. To avoid tracheotomy, the patient was extubated postoperatively and transitioned to NIPPV immediately utilizing a full‐face positive pressure mask with a soft and flexible sealing layer. The patient was successfully transitioned to NIPPV immediately after extubation. The free flap exhibited no signs of vascular compromise postoperatively, and healed very well. Conclusion Postoperative non‐invasive positive pressure ventilation can be successfully applied following complex microvascular midface reconstruction to avoid tracheotomy in select patients without vascular compromise of the free flap.
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Affiliation(s)
- Andrew R Larson
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Jenny X Chen
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Allison Holman
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.,Department of Speech, Language, and Swallowing Disorders, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stacey Sullivan
- Department of Speech, Language, and Swallowing Disorders, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Purris Williams
- Sean M. Healy & AMG Center for ALS, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Katharine Nicholson
- Sean M. Healy & AMG Center for ALS, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Derrick T Lin
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Yuka Kiyota
- Department of Anesthesiology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Jeremy D Richmon
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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Koyama Y, Tsuzaki K, Shimizu H, Kuroda J, Shimizu S. Successful bilevel positive airway pressure therapy in a patient with amyotrophic lateral sclerosis after emergency laparotomy: A case report. Saudi J Anaesth 2020; 14:538-540. [PMID: 33447203 PMCID: PMC7796744 DOI: 10.4103/sja.sja_375_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 11/04/2022] Open
Abstract
Patients with amyotrophic lateral sclerosis (ALS) present an increased risk of postoperative respiratory failure after general anesthesia. We report the case of a 71-year-old man with ALS who underwent emergency laparotomy for small bowel strangulation. After surgery, he remained intubated and was transferred to the high care unit under mechanical ventilation, due to unstable hemodynamics requiring inotropic support. On postoperative day (POD) 3, he was extubated under stable hemodynamics and respiratory status. Immediately after extubation, bilevel positive airway pressure (bilevel PAP) was prophylactically applied to prevent postoperative respiratory failure, which may have been caused by respiratory muscle fatigue, attributed to general anesthesia and surgical stress. On POD 7, bilevel PAP was smoothly weaned off because no signs and symptoms of respiratory failure were observed. On POD 10, he achieved 30 m-walk without rest. No postoperative complications were observed up to one month after surgery. Postoperative respiratory failure may lead to death in patients with neuromuscular disorder. Non-invasive ventilation (NIV) reduces respiratory muscle fatigue, resulting in easy sputum expectoration, promoting CO2 washout, and better oxygenation. Consequently, the prophylactic use of NIV to avoid postoperative respiratory insufficiency should be considered in patients with ALS after emergency operation under general anesthesia.
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Affiliation(s)
- Yukihide Koyama
- Department of Anesthesia, Nippon Koukan Hospital, Kawasaki, Japan
| | - Koichi Tsuzaki
- Department of Anesthesia, Nippon Koukan Hospital, Kawasaki, Japan
| | - Hideaki Shimizu
- Department of Surgery, Nippon Koukan Hospital, Kawasaki, Japan
| | - Junko Kuroda
- Department of Surgery, Nippon Koukan Hospital, Kawasaki, Japan
| | - Soichi Shimizu
- Department of Surgery, Nippon Koukan Hospital, Kawasaki, Japan
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7
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Wu X, Yang L. Quadratus Lumborum and modified Erector Spinae Plane (QLESP) block: A single-puncture technique for total hip arthroplasty. J Clin Anesth 2019; 61:109643. [PMID: 31668470 DOI: 10.1016/j.jclinane.2019.109643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 10/11/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Xi Wu
- Department of Anesthesiology, Institute of Anesthesiology and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Lei Yang
- Department of Anesthesiology, Institute of Anesthesiology and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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8
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Troppmann C, Santhanakrishnan C, Sageshima J, McVicar J, Perez R. Barriers to live and deceased kidney donation by patients with chronic neurological diseases: Implications for donor selection, donation timing, logistics, and regulatory compliance. Am J Transplant 2019; 19:2168-2173. [PMID: 30582272 DOI: 10.1111/ajt.15230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/09/2018] [Accepted: 12/12/2018] [Indexed: 01/25/2023]
Abstract
Live and deceased kidney donation by the numerous patients with advanced, progressive systemic neurological diseases, and other chronic neurological conditions (eg, high C-spine injury) remains largely unexplored. In a review of our current clinical practice, we identified multiple regulatory and clinical barriers. For live donation, mandatory reporting of postdonation donor deaths within 2 years constitutes a strong programmatic disincentive. We propose that the United Network for Organ Sharing should provide explicit regulatory guidance and reassurance for programs wishing to offer live donation to patients at higher risk of death during the reporting period. Under the proposal, live donor deaths within 30 days would still be regarded as donation-related, but later deaths would be related to the underlying disease. For deceased donation, donation after circulatory death (DCD) immediately following self-directed withdrawal of life-sustaining treatment ("conscious DCD") is not universally covered by existing DCD agreements with donor hospitals. Organ procurement organizations should thus systematically strive to revise these agreements. Obtaining adequate first-person consent from these communicatively severely impaired patients may be challenging. Optimized preservation and allocation protocols may maximize utilization of these DCD kidneys. Robust public debate and action by all stakeholders is necessary to lower existing barriers and maximize donation opportunities for patients with chronic neurological conditions.
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Affiliation(s)
- Christoph Troppmann
- Department of Surgery, University of California, Davis, School of Medicine, Sacramento, California
| | | | - Junichiro Sageshima
- Department of Surgery, University of California, Davis, School of Medicine, Sacramento, California
| | - John McVicar
- Department of Surgery, University of California, Davis, School of Medicine, Sacramento, California
| | - Richard Perez
- Department of Surgery, University of California, Davis, School of Medicine, Sacramento, California
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9
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Hoeper AM, Barbara DW, Watson JC, Sprung J, Weingarten TN. Amyotrophic lateral sclerosis and anesthesia: a case series and review of the literature. J Anesth 2019; 33:257-265. [PMID: 30656405 DOI: 10.1007/s00540-019-02611-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/08/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that leads to death due to respiratory failure. This report describes the perioperative characteristics of ALS patients who underwent procedures with anesthesia at our institution. METHODS We reviewed perioperative records of ALS patients who underwent procedures with anesthesia from January 1, 2014, through December 31, 2015. RESULTS Seventy-eight patients underwent 89 procedures (71 procedures with monitored anesthesia care and 18 with general anesthesia), including 45 gastrostomy tube placements and 18 bone marrow biopsies. Three patients had prolonged duration of postoperative intubation related to preexisting respiratory muscle weakness, and one patient with bilateral pneumothorax required tracheal reintubation for respiratory distress. Four patients had prolonged duration of hospitalization. Three patients were hospitalized for ALS-related complications, and one patient was hospitalized for respiratory distress when pneumoperitoneum developed after gastrostomy tube placement. Three of these patients died of complications attributable to ALS within 30 days of the procedure. Twenty-nine (32.6%) procedures required minimal sedation (e.g., bone marrow biopsy, cataract surgery) and were performed on an ambulatory basis. CONCLUSION When caring for patients with ALS, the perioperative team must be prepared to treat potentially complex medical conditions that may not be directly related to the procedure and anesthetic management. However, minor procedures performed with minimal sedation may be safely performed on an ambulatory basis.
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Affiliation(s)
- Alan M Hoeper
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - David W Barbara
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - James C Watson
- Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Juraj Sprung
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Toby N Weingarten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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10
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Kusakai M, Sawada A, Kii N, Tokinaga Y, Hirata N, Yamakage M. Epidural anesthesia combined with sedation with dexmedetomidine for appendectomy in a patient with amyotrophic lateral sclerosis: a case report. JA Clin Rep 2018; 4:82. [PMID: 32026029 PMCID: PMC6966754 DOI: 10.1186/s40981-018-0220-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 12/17/2018] [Indexed: 11/10/2022] Open
Abstract
Background Patients with amyotrophic lateral sclerosis (ALS) present increased risks for anesthesia-related complications. We present a case of epidural anesthesia combined with sedation with dexmedetomidine for open appendectomy in a patient with ALS who refused invasive mechanical ventilation. Case presentation A 50-year-old man with a 3-year history of ALS was scheduled to undergo open appendectomy due to repeated appendicitis. He refused to undergo invasive mechanical ventilation using an endotracheal tube. Hence, we decided to administer epidural anesthesia combined with sedation with dexmedetomidine for anesthesia during the surgical procedure. The patient underwent open appendectomy without complications and with no pain or discomfort during surgery. There were no neurological complications at the 3-month follow-up after surgery. Conclusions Epidural anesthesia combined with sedation with dexmedetomidine may be effective for the anesthetic management of patients who would benefit from regional anesthesia.
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Affiliation(s)
- Mikako Kusakai
- Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Japan
| | - Atsushi Sawada
- Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Japan.
| | - Natsumi Kii
- Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Japan
| | - Yasuyuki Tokinaga
- Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Japan
| | - Naoyuki Hirata
- Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Japan
| | - Michiaki Yamakage
- Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Japan
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Kock-Cordeiro D, Brusse E, van den Biggelaar R, Eggink A, van der Marel C. Combined spinal-epidural anesthesia with non-invasive ventilation during cesarean delivery of a woman with a recent diagnosis of amyotrophic lateral sclerosis. Int J Obstet Anesth 2018; 36:108-110. [DOI: 10.1016/j.ijoa.2018.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 05/20/2018] [Accepted: 06/01/2018] [Indexed: 11/25/2022]
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12
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Epidural anesthesia for open gastrostomy in a patient with amyotrophic lateral sclerosis. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2018. [DOI: 10.1097/cj9.0000000000000051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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13
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Hadaya IA, Gray AT, Braehler MR. Baclofen Pump Replacement in a Patient With End-Stage Amyotrophic Lateral Sclerosis: A Case Report Demonstrating Transversus Abdominis Plane Block as the Sole Anesthetic. A A Pract 2018; 10:251-253. [PMID: 29757792 DOI: 10.1213/xaa.0000000000000676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A patient with end-stage amyotrophic lateral sclerosis (ALS) presented for Baclofen pump replacement. She underwent a left transversus abdominis plane block to anesthetize the left lower quadrant of the abdomen. No sedatives or analgesics were administered, and the procedure was successfully completed without complication. It is prudent to consider anesthetic plans that avoid complications associated with general or neuraxial anesthesia in patients with ALS. This case report demonstrates successful placement of a transversus abdominis plane block in a patient with ALS and offers a safe anesthetic technique that can be performed in other high-risk patients.
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Affiliation(s)
- Iman A Hadaya
- From the Department of Anesthesia and Perioperative Care, University of California, San Francisco, California
| | - Andrew T Gray
- Department of Anesthesia and Perioperative Care, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, California
| | - Matthias R Braehler
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, California
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14
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You TM, Kim S. Pulseless electrical activity during general anesthesia induction in patients with amyotrophic lateral sclerosis. J Dent Anesth Pain Med 2017; 17:235-240. [PMID: 29090256 PMCID: PMC5647820 DOI: 10.17245/jdapm.2017.17.3.235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 11/15/2022] Open
Abstract
Pulseless electrical activity (PEA) is a clinical condition characterized by unresponsiveness and lack of palpable pulse in the presence of organized cardiac electrical activity and is caused by a profound cardiovascular insult (e.g., severe prolonged hypoxia or acidosis, extreme hypovolemia, or flow-restricting pulmonary embolus). Amyotrophic lateral sclerosis (ALS) is a disease that is characterized by progressive degeneration of all levels of the motor nervous system. Damage to the respiratory system and weakness of the muscles may increase the likelihood of an emergency situation occurring in patients with ALS while under general anesthesia. We report a case of PEA during the induction of general anesthesia in a patient with ALS who presented for dental treatment and discuss the causes of PEA and necessary considerations for general anesthesia in patients with ALS.
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Affiliation(s)
- Tae Min You
- Department of Advanced General Dentistry, School of Dentistry, Dankook University, Cheonan, Korea
| | - Seungoh Kim
- Department of Anesthesiology, School of Dentistry, Dankook University, Cheonan, Korea
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15
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Xiao W, Zhao L, Wang F, Sun H, Wang T, Zhao G. Total intravenous anesthesia without muscle relaxant in a parturient with amyotrophic lateral sclerosis undergoing cesarean section: A case report. J Clin Anesth 2017; 36:107-109. [DOI: 10.1016/j.jclinane.2016.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/15/2016] [Accepted: 10/27/2016] [Indexed: 12/11/2022]
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Abstract
PURPOSE OF REVIEW Amyotrophic lateral sclerosis (ALS) is a progressive, incurable and fatal neurodegenerative disease. Few interventions significantly alter the disease course, but many symptomatic treatments exist to improve patients' quality of life. In this review, we describe our approach to symptomatic management of ALS and discuss the underlying evidence base. RECENT FINDINGS Discussion focuses predominantly on recently published articles. We cover management settings, disease-modifying treatment, vitamin D, respiratory management including noninvasive ventilation and diaphragmatic pacing, secretions, nutrition, dysphagia and gastrostomy, communication problems, mobility, spasticity, pain, cognition, depression and emotional lability, fatigue, sleep disturbance, head drop, prevention of deep venous thrombosis and end-of-life issues. SUMMARY Multidisciplinary specialist care appears to improve quality of life and survival. Riluzole remains the only available disease-modifying medication and confers a survival advantage of 2-3 months. Noninvasive ventilation improves quality of life and extends survival by approximately 7 months, at least in patients without severe bulbar problems. Nutrition is an independent prognostic factor; whether gastrostomy improves survival and quality of life remains unclear and further studies are underway. Many other symptomatic treatments appear helpful to individuals in clinic, but further randomized clinical trials are required to provide a more robust evidence base.
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Karam CY, Paganoni S, Joyce N, Carter GT, Bedlack R. Palliative Care Issues in Amyotrophic Lateral Sclerosis: An Evidenced-Based Review. Am J Hosp Palliat Care 2014; 33:84-92. [PMID: 25202033 DOI: 10.1177/1049909114548719] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
As palliative care physicians become increasingly involved in the care of patients with amyotrophic lateral sclerosis (ALS), they will be asked to provide guidance regarding the use of supplements, diet, exercise, and other common preventive medicine interventions. Moreover, palliative care physicians have a crucial role assisting patients with ALS in addressing health care decisions to maximize quality of life and cope with a rapidly disabling disease. It is therefore important for palliative care physicians to be familiar with commonly encountered palliative care issues in ALS. This article provides an evidenced-based review of palliative care options not usually addressed in national and international ALS guidelines.
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Affiliation(s)
- Chafic Y Karam
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Sabrina Paganoni
- Harvard Medical School, Massachusetts General Hospital, Spaulding Rehabilitation Hospital, and Boston VA Healthcare System
| | - Nanette Joyce
- Department of Physical Medicine and Rehabilitation, Neuromuscular Section, University of California, Davis Medical School, Sacramento, CA, USA
| | - Gregory T Carter
- Department of Physical Medicine and Rehabilitation St Luke's Rehabilitation Institute, Spokane, WA, USA
| | - Richard Bedlack
- Duke University School of Medicine, and Durham Veterans Affairs Medical Center, Durham, NC, USA
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