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환기보조를 받는 근위축성 측색 경화증 환자에서 시행한 지속적 경막외 마취

Continuous Epidural Anesthesia in a Patient with Amyotrophic Lateral Sclerosis on Ventilatory Support

경희의학 2019년 34권 1호 p.80 ~ 83
임영섭 ( Lim Young-Seob ) - Eulji University Eulji General Hospital Department of Anesthesiology and Pain Medicine

 ( Kim Hyoung-Gyun ) - Eulji University Eulji General Hospital Department of Anesthesiology and Pain Medicine
 ( Kang Hyo-Seok ) - Eulji University Eulji General Hospital Department of Anesthesiology and Pain Medicine

Abstract


Background: Amyotrophic lateral sclerosis (ALS) is chronic progressive motor neuron disorder, not affecting sensory and autonomic function. As the disease progresses, a respiratory depression appears. Anesthesia and postoperative pain control in patient with ALS is challenging problems.

Case Report: 56 years old man was scheduled for open reduction and internal fixation on the left distal femur. He was diagnosed with Lou Gehrig’s Disease 10 years ago, and had tracheostomy 4 years ago. He used home ventilator and was unable to move by himself below the neck and. We chose epidural anesthesia with catheter to control the pain during the surgery and postoperative period. His home ventilator was to be used during surgery. Blocked sensory level was T12 by 0.75% hyperbaric ropivacaine 10 mL and he was stable during surgery. After 48 hours epidural catheter removed, no aggravation of neurologic and respiratory signs or symptoms were noted until he discharged.

Discussion: ALS is characterized as neurodegenerative disease. Patient is progressively paralyzed while remaining fully alert. Respiratory failure is the main cause of death of ALS. General anesthesia can cause the increase in weakness of the respiratory function. Spinal and epidural anesthesia are not contraindication in ALS, and there is no data that spinal epidural anesthesia deteriorates neurologic function in patients with degenerative disease.

Conclusion: ALS patient receiving ventilatory support successfully underwent the operation on the left distal femur under continuous epidural anesthesia without neurologic and respiratory aggravation.

키워드

Amyotrophic Lateral Sclerosis; Epidural anesthesia; Ventilatory support
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