Abstract
Amyotrophic Lateral Sclerosis is a rapidly progressive disease from the fi fth to sixth decades of life causing degeneration and death of the upper and lower motor neurons and no effective treatment. The diagnosis isdependent on the clinical presentation and consistent electrodiagnostic studies. Progressive denervation affects the muscles, causing muscular weakness and atrophy, when the ventilation muscles are affected deathdue to respiratory failure occurs within a few years. We present the case of a 54 years old, 180 cm height and 94 kg weight male patient with amyotrophic lateral sclerosis who underwent surgical treatment of thyroidcancer. Fiberoptic intubation was orally performed providing spontaneus breathing. Propofol was applied after passing vocal cords. Anesthesia was maintained with sevofl orane (%2) and a mixture of oxygen and airunder volume controlled ventilation. Rocuronium was used 20 mg at the beginning of the surgery. At the end of surgery, he wasn’t extubated and transferred to anesthesia intensive care unit. He was extubated after tenhours and he was awaked perfectly. The patient was discharged from intensive care unit after 24 hours and from hospital after ten days. We reported that amyotrophic lateral sclerosis patient with limited mouth opening who underwent thyroid surgery, using awake intubation.
Highlights
Amyotrophic lateral sclerosis (ALS) is a progressive neurologic disease of motor ganglia in the anterior horn of the spinal cord and spinal pyramidal tracts
We preferred awake fiberoptic intubation for our patient since we didn’t want to use neuromuscular blockage agents for anesthesia induction and difficult intubation was thought for limited mouth opening
Lots of techniques for fiberoptic intubation are known and used, there is an association of thoughts for some important points
Summary
Introduction Amyotrophic lateral sclerosis (ALS) is a progressive neurologic disease of motor ganglia in the anterior horn of the spinal cord and spinal pyramidal tracts. Anesthesia procedures in patients with ALS often require certain special consideration [2]. It hasn’t been reported on anesthesia procedures in awake fiberoptic intubated patient with ALS. Case report A 54 years old, 180 cm height and 94 kg weight is a male patient with ALS who underwent surgical treatment of thyroid cancer. He had no difficulty in speaking, but a little difficulty in swallowing.
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