Case 19: A Patient with Amyotrophic Lateral Sclerosis
Today you are assigned to anesthetize a patient with amyotrophic lateral sclerosis (ALS). He is 43 years old and weighs 65 kg and is 5 ft 10 in. tall. The patient is having diaphragmatic pacer (DPS) placed prophylactically. DPS is used to treat ventilator insufficiency in quadriplegic patients [1, 2]. The operation will be done laparoscopically. He is otherwise healthy with a forced vital capacity greater than 50% and a normal EKG. You premedicate him with 1 mg of midazolam and 10 mg of metoclopramide. In the operating room you place routine monitors and a remifentanil infusion of 0.05 mcg/kg/min is started. Anesthesia is induced with 150 mg of propofol. He is easily ventilated with 100% oxygen with 3% sevoflurane. No muscle relaxant is used at induction or at any time during the procedure. The trachea is sprayed with 160 mg of lidocaine (LTA 360 Kit, Hospira, Inc., Lake Forest, IL 60045) and a cuffed endotracheal tube (ETT) is placed.
KeywordsAmyotrophic lateral sclerosis General anesthesia Diaphragm pacing
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