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?
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.
- 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.