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.

References

1. Berciano Blanco JA. Farreras Valentí P. Síndromes espinocerebelosos y enfermedades de la motoneurona. Medicina Interna Decimosexta ed, Barcelona:2008;1493-1496.

2. Vaquero Roncero M, Valdunciel García J. Enfermedades neurológicas en anestesia para patologías poco habituales. Primera 1 ed. Salamanca; 2015: 123-125.

3. Amit P, Christopher Paul O, Alan David K. Anesthetic management of the patient with amyotrophic lateral sclerosis. J Anesth 2013;27:909-918.

4. Vercauteren M, heytens L. Anaesthetic considerations for patients with a pre-existing neurological déficit: are neuraxial techniques safe? Acta Anaesthesiol Scand 2007;51:831-838.

5. Ki-Bum P, Byungdoo S, Doo-Young H, et al. Spinal anesthesic management for discectomy in a patient with amyotrophic lateral sclerosis: a case report. Korean J Anesthesiol 2012;63:547-549.

6. Prabhakar A, Owen CP, Kaye AD. Anesthetic management of the patient with amyotrophic lateral sclerosis. J Anesth 2013;27:909-918.

7. Umegaki H, Tagami N. Anesthetic management of an ALS patient with remifentanil. Masui 2008;57:1139-1142.

8. Wakimoto M, Nagata H, Kumagai M, et al. Anesthetic management for a patient with amyotrophic lateral sclerosis; the neuromuscular monitoring was useful to determine appropriate dosages of rocuronium. Masui 2012;61:599-601.

9. Kelsaka E, Karakaya D, Zengin EC. Use of sugammadex in a patient with amyotrophic lateral sclerosis. Med Princ Pract 2013;22:304-306.

10. Thampi SM, David D, Chandy TT, et al. Anesthetic management of a patient with amyotrophic lateral sclerosis for transurethral resection of bladder tumor. Indian J Anaesth 2013;57:197-199.

11. Park KB, Son B, Hwang DY, et al. Spinal anesthetic management for discectomy in a patient with amyotrophic lateral sclerosis: a case report. Korean J Anesthesiol 2012;63:547-549.

12. Otsuka N, Igarashi M, Shimodate Y, et al. Anesthetic management of two patients with amyotrophic lateral sclerosis (ALS). Masui 2004;53:1279-1281.

13. Thampi SM, David D, Thomson Chandy T, et al. Anesthesic management of a patient with amyotrophic lateral sclerosis for transurethral of bladder tumor. Indian J Anaesthe 2013;57:197-199.

14. Nozari A, Bagchi A, Saxena Ry. Miller RD, et al. Enfermedades Neuromusculares y otras enfermedades genéticas. Anesthesia, 8 ed. Churchill Livingstone Inc, Philadelphia, PA:2015;1272-1273.

15. Hara K, Sakura S, Saito Y, et al. Epidural anesthesia and pulmonary function in a patient with amyotrophic lateral sclerosis. Anesth Analg 1996;83:878-879.

16. Berde CB, Strichartz GR. Miller RD. Anestésicos locales. Anesthesia, 8 ed. Churchill Livingstone Inc, Philadelphia, PA:2015;1028-1054.
How to Cite
1.
Ruiz-Chirosa MDC, Nieto-Martín L, García-Fernández E, Vaquero-Roncero LM, Sánchez-Montero JM, Alonso-Guardo L, Calvo-Vecino JM. Epidural anesthesia for open gastrostomy in a patient with amyotrophic lateral sclerosis. Colomb. J. Anesthesiol. [Internet]. 2018Jul.1 [cited 2022Jul.6];46(3):248-51. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/540

Downloads

Download data is not yet available.
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, Calvo-Vecino JM. Epidural anesthesia for open gastrostomy in a patient with amyotrophic lateral sclerosis. Colomb. J. Anesthesiol. [Internet]. 2018Jul.1 [cited 2022Jul.6];46(3):248-51. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/540
Section
Case Report / Case Series

More on this topic