PDF(Pubmed)
Abstract：
Patients with amyotrophic lateral sclerosis (ALS) who undergo lower extremity joint arthroplasty are rarely encountered. Patients with ALS are at an increased risk for perioperative anesthetic complications. Anesthetic techniques, regional or general, present different risks to patients with ALS. The historical concern of worsening pre-existing neurologic symptoms with regional anesthesia is being re-examined in light of emerging evidence supporting its use in patients with ALS. Here, we present the successful perioperative management of a patient with severe bulbar ALS undergoing total knee arthroplasty. Despite his advanced bulbar symptoms, he was independently ambulatory with severe knee pain related to osteoarthritis. During multidisciplinary planning with the patient and his wife, it became clear that his primary perioperative concern was avoiding intubation, prolonged ventilation, and tracheostomy placement. With this in mind, we planned for a neuraxial anesthetic without intraoperative sedation, a postoperative adductor canal peripheral nerve block, and multimodal non-opioid analgesia. There were no perioperative complications. At the six-week follow-up, he experienced improved ambulation and showed no signs of worsened ALS symptoms.
摘要：
很少遇到接受下肢关节置换术的肌萎缩侧索硬化症（ALS）患者。ALS患者围手术期麻醉并发症的风险增加。麻醉技术,区域或一般，给ALS患者带来不同的风险。鉴于支持将其用于ALS患者的新证据，正在重新审查区域麻醉使先前存在的神经系统症状恶化的历史关注。这里,我们介绍了1例严重球ALS患者行全膝关节置换术的成功围手术期治疗.尽管他有延髓症状，他独立走动，患有与骨关节炎相关的严重膝关节疼痛。在与病人和他的妻子进行多学科计划时，很明显，他在围手术期的主要关注点是避免插管，长时间通风，和气管造口术。考虑到这一点，我们计划在没有术中镇静的情况下进行神经轴麻醉，术后内收肌管周围神经阻滞，和多模式非阿片类镇痛。无围手术期并发症。在六周的随访中，他的步行情况有所改善，没有表现出ALS症状恶化的迹象。
