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

Alan M. Hoeper, David W. Barbara, James Watson, Juraj Sprung, Toby N. Weingarten

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalJournal of Anesthesia
DOIs
StateAccepted/In press - Jan 1 2019

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Amyotrophic Lateral Sclerosis
Anesthesia
Gastrostomy
Bone Marrow
Biopsy
Pneumoperitoneum
Respiratory Muscles
Muscle Weakness
Pneumothorax
Intubation
Respiratory Insufficiency
Neurodegenerative Diseases
Cataract
General Anesthesia
Anesthetics
Hospitalization

Keywords

  • Amyotrophic lateral sclerosis
  • Anesthesia
  • Outcomes

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Amyotrophic lateral sclerosis and anesthesia : a case series and review of the literature. / Hoeper, Alan M.; Barbara, David W.; Watson, James; Sprung, Juraj; Weingarten, Toby N.

In: Journal of Anesthesia, 01.01.2019.

Research output: Contribution to journalArticle

Hoeper, Alan M. ; Barbara, David W. ; Watson, James ; Sprung, Juraj ; Weingarten, Toby N. / Amyotrophic lateral sclerosis and anesthesia : a case series and review of the literature. In: Journal of Anesthesia. 2019.
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