Epidural anesthesia for open gastrostomy in a patient with amyotrophic lateral sclerosis

  • María Del Carmen Ruiz-Chirosa a Anaesthesia Service, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain.
  • Laura Nieto-Martín a Anaesthesia Service, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain.
  • Elena García-Fernández a Anaesthesia Service, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain.
  • Luis Mario Vaquero-Roncero a Anaesthesia Service, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain.
  • José Manuel Sánchez-Montero a Anaesthesia Service, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain.
  • Laura Alonso-Guardo a Anaesthesia Service, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain.
  • José María Calvo-Vecino a Anaesthesia Service, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain.
Keywords: Amyotrophic Lateral Sclerosis, Gastrostomy, Anesthesia, Neuromuscular Diseases, Anesthesia Epidural

Abstract

Amyotrophic lateral sclerosis is characterized by the progressive degeneration of motor neurons, causing a constellation of symptoms that include muscle weakness, atrophy, fasciculations, spasticity, and hyperreflexia. Currently, Rulizol is the only treatment that has been shown to delay its progression, though to a very small extent. Disease prognosis is grim, with death caused mainly by respiratory failure secondary to muscle weakness, making anesthetic management of these patients a true challenge. The use of muscle relaxants must be avoided as much as possible because of the high risk of ventilatory depression, considering that these patients have an abnormal unpredictable response as a result of heightened sensitivity related to the lower number of acetylcholine receptors. If muscle relaxants are required during the surgery, rocuronium, among nondepolarizing muscle relaxants, is the drug of choice because of its short half-life, while depolarizing relaxants such as succinylcholine are contraindicated because of the risk of lethal hyperkalemia. In terms of intraoperative hypnotics and analgesics, propofol and remifentanil are ideal because of their short half-life.

Regarding neuroaxial anesthesia, despite widespread reluctancy to use it, its benefits and rather uncommon adverse effects lead many anesthetists to consider it as an important alternative when it comes to deciding between general or neuroaxial anesthesia, because it reduces airway manipulation significantly, thus reducing respiratory complications as described in this clinical case.

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How to Cite
1.
Ruiz-Chirosa MDC, Nieto-Martín L, García-Fernández E, Vaquero-Roncero LM, Sánchez-Montero JM, Alonso-Guardo L, et al. Epidural anesthesia for open gastrostomy in a patient with amyotrophic lateral sclerosis. Colomb. J. Anesthesiol. [Internet]. 2018 Jul. 1 [cited 2024 Mar. 29];46(3):248-51. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/540

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Published
2018-07-01
How to Cite
1.
Ruiz-Chirosa MDC, Nieto-Martín L, García-Fernández E, Vaquero-Roncero LM, Sánchez-Montero JM, Alonso-Guardo L, et al. Epidural anesthesia for open gastrostomy in a patient with amyotrophic lateral sclerosis. Colomb. J. Anesthesiol. [Internet]. 2018 Jul. 1 [cited 2024 Mar. 29];46(3):248-51. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/540
Section
Case Report / Case Series

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