ALS and General Anesthesia

I had a case with a patient who was newly diagnosed with ALS.  They had recently had a fall and was coming in for a TEE (for pre-Watchman workup), AV node ablation, and pacemaker placement.  There was some mild lower extremity weakness.  Upper extremity strength seemed to be 5/5.  The patient recently passed a swallow evaluation.  The plan was for a GA.

What is ALS?

From http://walkforals.ca/what-is-als/

ALS Association: What is ALS?

ALS Association: Signs and Symptoms

 

Considerations in ALS patients for GA:

• Use of sugammadex in a patient with progressive muscular atrophy and in a patient with amyotrophic lateral sclerosis: Case report. Medicine (Baltimore). 2017 Jun; 96(23): e7098.
• Administering Anesthesia for Patients with ALS Having a Diaphragmatic Pacemaker Placed: Special Considerations. Open Journal of Anesthesiology, 2014, 4, 223-226.

 

My plan:

• Induction: propofol, remifentanil. I avoided paralytics.
• Pain control: remifentanil, local anesthetic by surgeon.
• Emergence: deep, patient breathing on their own
• Dropoff in PACU: patient wide awake and comfortable.