Abstract
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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Onders RP, Elmo KJ, Ignagni AR. Diaphragm pacing stimulation system for tetraplegia in individuals injured during childhood or adolescence. J Spinal Cord Med. 2007;30:S25–9.
Dimarco AF, Onders RP, Kowalski KE, Miller ME, Ferek S, Mortimer JT. Phrenic nerve pacing in a tetraplegic patient via intramuscular diaphragm electrode. Am J Respir Crit Care Med. 2002;166:1604–6.
Schmiesing CA, Lee J, Morton JM, Brock-Utne JG. Laparascopic diaphragmatic pacer placement – a potential new treatment for ALS patients: a brief description of the device and anesthestic issues. J Clin Anesth. 2010;22:549–52.
Mitusmuto H. The clinical features and prognosis in ALS. In: Mitsumoto H, Munsat T, editors. Amyotropic lateral sclerosis. A guide for patients and families. 2nd ed. New York: Demos; 2001. p. 27.
Asai H, Hirano M, Udaka F, Shimada K, Oda M, Kubori T, et al. Sympathetic disturbances increase risk of sudden cardiac arrest in sporadic ALS. J Neurol Sci. 2007;254:78–83.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
Copyright information
© 2012 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Brock-Utne, J.G. (2012). Case 19: A Patient with Amyotrophic Lateral Sclerosis. In: Case Studies of Near Misses in Clinical Anesthesia. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1179-7_19
Download citation
DOI: https://doi.org/10.1007/978-1-4419-1179-7_19
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4419-1178-0
Online ISBN: 978-1-4419-1179-7
eBook Packages: MedicineMedicine (R0)