Amyotrophic lateral sclerosis and anesthesia: a case series and review of the literature

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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Fig. 1

Abbreviations

ALS:

Amyotrophic lateral sclerosis

ALSFRS-R:

Amyotrophic lateral sclerosis functional rating scale-revised

EMG:

Electromyography

MAC:

Monitored anesthesia care

PEG:

Percutaneous endogastric gastrostomy

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Correspondence to Toby N. Weingarten.

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Conflict of interest

TNW currently serves as a consultant to Medtronic in the role as chairman of the Clinical Endpoint Committee for the Prodigy Trial; has received research support from Respiratory Motion (study equipment) and unrestricted investigator-initiated grants from Merck (active) and Baxter (completed).

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Hoeper, A.M., Barbara, D.W., Watson, J.C. et al. Amyotrophic lateral sclerosis and anesthesia: a case series and review of the literature. J Anesth 33, 257–265 (2019). https://doi.org/10.1007/s00540-019-02611-x

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Keywords

  • Amyotrophic lateral sclerosis
  • Anesthesia
  • Outcomes