ALS Tanılı Olguda Trakeostomi Operasyonu: Anestezi Yönetimi
Özet
Altmış dört yaşında, amyotrofik lateral skleroz (ALS) tanısı olan erkek hasta ciddi nefes darlığı şikayeti ile hastanemize başvurdu. Genel durumu orta, bilinç açık, ajite ve ciddi solunum sıkıntısı ve stridoru mevcuttu. 6 L dk-1 hızda oksijen (O2 ) oronazal maske ile periferik oksijen satürasyonu (SpO2) %88 idi. Yapılan muayene ve tetkikler sonucunda hastada bilateral vokal kord paralizisi tespit edildi ve acil trakeostomi operasyonu planlandı. Ameliyathane şartlarında standart anestezi monitörizasyonu yapıldı. Hasta 8 L dk-1, %100 O2 ile 3 dakika (dk) preoksijenize edildi. Anestezi indüksiyonunda lidokain hidroklorür 1mg kg-1, remifentanil 1 µg kg-1 ve propofol 2 mg kg-1 intravenöz (İV) olarak uygulandı. Nöromüsküler blokör (NMB) bir ajan kullanılmadı. Hasta 7,0 numara kaflı spiralli endotrakeal tüple entübe edildi. İdamede propofol ilk 20 dk 12 mg kg-1 saat-1, ikinci 20 dk 9 mg kg-1 saat-1 İV infüzyon ve remifentanil 0.05 µg kg-1 dk1 İV infüzyon şeklinde uygulandı. Hasta operasyon boyunca stabil seyretti. Trakeostomi açıklığı sağlandıktan sonra ventilasyona trakeostomiden devam edildi. Operasyon sonrası spontan solunumu olan hasta postoperatif yakın gözlem amaçlı yoğun bakım ünitesine devredildi.
Sixty four-years-old man with amyotrophic lateral sclerosis (ALS) was admitted to our hospital with severe dyspnea. His general condition was moderate, consciousness was clear, agitated and he had severe respiratory distress and stridor. SpO2 was 88% with O2 oronasal mask at 6 L min-1 rate. After examination and investigations, bilateral vocal cord paralysis was detected and emergency tracheostomy operation was planned. Standard anesthesia monitoring was performed under operating room conditions. The patient was preoxygenated with 8 liters min-1, 100% O2 for 3 minutes. Lidocaine hydrochloride 1 mg kg-1, remifentanil 1 µg kg-1 and propofol 2 mg kg-1 were administered intravenously (IV) for induction of anesthesia. No neuromuscular blocker (NMB) agent was used. The patient was intubated with a 7.0 cuffed spiral endotracheal tube. Propofol was administered as 12 mg kg-1 h-1 for the first 20 min, 9 mg kg-1 h-1 IV infusion for the second 20 min and remifentanil 0.05 µg kg-1 min-1 IV infusion. The patient was stable throughout the operation. After tracheostomy patency was established, ventilation was continued through the tracheostomy. The patient who had spontaneous respiration after the operation was transferred to the intensive care unit for close postoperative observation.
Referanslar
Creemers H, Grupstra H, Nollet F, et al. Prognostic factors for the course of functional status of patients with ALS: a systematic review. J Neurol. 2015;262(6):1407–1423. doi: 10.1007/s00415-014-7564-8
Leigh PN, Abrahams S, Al-Chalabi A, et al. the King’s MND care and Research Team. The Management of Motor Neurone Disease. J Neurol Neurosurg Psychiatry. 2003;74 (Suppl IV): 32-47. doi: 10.1136/jnnp.74.suppl_4.iv32
Lechtzin N. Respiratory Effects of Amyotrophic Lateral Sclerosis: Problems and Solutions. Respir Care 2006;51(8):871– 881.
Miller RG, Mitchell JD, Moore DH. Riluzole for amyotrophic lateral sclerosis (ALS)/motor neuron disease (MND). Cochrane Database Syst Rev. 2012;14(3):CD001447. doi: 10.1002/14651858.CD001447
Prabhakar A, Owen CP, Kaye AD. Anesthetic management of the patient with amyotrophic lateral sclerosis. J Anesth. 2013;27(6):909–918. doi: 10.1007/s00540-013-1644-2
Gregory S, Siderowf A, Golaszewski AL, et al. Gastrostomy insertion in ALS patients with low vital capacity: respiratory support and survival. Neurology. 2002;58(5):485-487. doi: 10.1212/wnl.58.3.485.
Hara K, Sakura S, Saito Y, et al. Epidural anesthesia and pulmonary function in a patient with amyotrophic lateral sclerosis. Anesth Analg. 1996;83(4):878-879 doi: 10.1097/00000539-199610000-00040.
Niedermeyer S, Murn M, Choi PJ. Respiratory failure in amyotrophic lateral sclerosis. Chest 2019; 155: 401–408. doi: 10.1016/j.chest.2018.06.035. Epub 2018 Jul 7.
Rafiq MK, Proctor AR, McDermott CJ, et al. Respiratory management of motor neurone disease: a review of current practice and new developments. Pract Neurol 2012; 12: 166 doi: 10.1136/practneurol-2011-000199.
Sachs C, Conradi S, Kaijser L. Autonomic function in amyotrophic lateral sclerosis: a study of cardiovascular responses. Acta Neurol Scand 1985; 71: 373–378. doi: 10.1111/j.1600-0404.1985.tb03215.x.
Murata Y, Harada T, Ishizaki F, et al. An abnormal relationship between blood pressure and pulse rate in amyotrophic lateral sclerosis. Acta Neurol Scand 1997; 96: 118–122 doi: 10.1111/j.1600-0404.1997.tb00251.x.
Lee D, Lee KC, Kim JY, et al. Total intravenous anesthesia without muscle relaxant in a patient with amyotrophic lateral sclerosis. J Anesth. 2008;22(4):443-445. doi: 10.1007/s00540-008-0655-x.
Kimura M, Saito S. Anesthesia for patients with neurological diseases. Masui. 2010; 59(9):1100-1104.
Diefenbach C, Buzello W. Muscle relaxation in patients with neuromuscular diseases. Anaesthesist. 1994;43(5):283-288 doi: 10.1007/s001010050059.
Mashio H, Ito Y, Yanagita Y, et al. Anesthetic management of a patient with amyotrophic lateral sclerosis. Masui. 2000;49(2):191-194
Beach TP, Stone WA, Hamelberg W. Circulatory collapse following succinylcholine: report of a patient with diffuse lower motor neuron disease. Anaesth Analg. 1971;50(3):431-437.
Chang YJ, Jung WS, Son WR, et al. Discordance between train-of-four response and clinical symptoms in a patient with amyotrophic lateral sclerosis. Acta Med Okayama 2014; 68: 125–127. doi: 10.18926/AMO/52409.
Moser B, Lirk P, Lechner M, et al. General anaesthesia in a patient with motor neuron disease. Eur J Anaesthesiol 2004; 21: 921–923. doi: 10.1017/s0265021504250281.
Roberts J, Reddy U. Neuromuscular disorders: relevance to anaesthesia and intensive care. Anaesth Intensive Care Med 2017; 18: 292–295.
Martin-Flores M, Gleed RD, Basher KL, et al. TOF-Watch(R) monitor: failure to calculate the train-of-four ratio in the absence of baseline calibration in anaesthetized dogs. Br J Anaesth 2012; 108: 240–244. doi: 10.1093/bja/aer378.
Racca F, Mongini T, Wolfler A, et al. Recommendations for anesthesia and perioperative management of patients with neuromuscular disorders. Minerva Anestesiologica 2013; 79: 419–433.
Wakimoto M, Nagata H, Kumagai M, et al. [Anesthetic management for a patient with amyotrophic lateral sclerosis; the neuromuscular monitoring was useful to determine appropriate dosages of rocuronium]. Masui 2012; 61: 599–601.
Kelsaka E, Karakaya D, Zengin EC. Use of sugammadex in a patient with amyotrophic lateral sclerosis. Med Princ Practice 2013; 22: 304. doi: 10.1159/000343168.
Nair VP, Hunter JM. Anticholinesterases and anticholinergic drugs. BJA Educ 2004; 4: 164–168.
Bartels K, Hunter JM. Neostigmine versus sugammadex: the tide may be turning, but we still need to navigate the winds. Br J Anaesth 2020; 124: 504–507. doi: 10.1016/j.bja.2020.02.021.
Yoo JH, Kim SI, Park SY, et al. Use of sugammadex in a patient with progressive muscular atrophy and in a patient with amyotrophic lateral sclerosis: Case report. Medicine 2017; 96: e7098–e7098. doi: 10.1097/MD.0000000000007098.
Klemola UM, Menander S, Saarnivaara L. Tracheal intubation without the use of muscle relaxants: remifentanil or alfentanil in combination with propofol. Acta Anaesthesiol Scand 2000;44(4):465-9 doi: 10.1034/j.1399-6576.2000.440419.x.
Erhan E, Ugur G, Alper I, et al. Tracheal intubation without muscle relaxants: remifentanil or alfentanil in combination with propofol. Eur J Anaesthesiol. 2003 Jan;20(1):37-43 doi: 10.1017/s0265021503000073.
Hoeper AM, Barbara DW, Watson JC, et al. Amyotrophic lateral sclerosis and anesthesia: a case series and review of the literature Journal of Anesthesia (2019) 33:257–265 doi: 10.1007/s00540-019-02611-x.
Shemisa K, Kaelber D, Parikh SA, et al. Autonomic etiology of heart block in amyotrophic lateral sclerosis: a case report. J Med Case Rep. 2014;8:224. doi: 10.1186/1752-1947-8-224 doi: 10.1186/1752-1947-8-224.
Hocking G, Wildsmith JA. Intrathecal drug spread. Br J Anaesth. 2004;93(4):568–578. doi: 10.1093/bja/aeh204.
Dripps RD, Vandam LD. Exacerbation of pre-existing neurologic disease after spinal anesthesia. N Engl J Med. 1956;255(18):843–849. doi: 10.1056/NEJM195611012551803
Kane RE. Neurologic deficits following epidural or spinal anesthesia. Anesth Analg. 1981;60(3):150–161. doi: 10.1213/00000539-198103000-00006
Hebl JR, Horlocker TT, Schroeder DR. Neuraxial anesthesia and analgesia in patients with preexisting central nervous system disorders. Anesth Analg. 2006;103(1):223–228. doi: 10.1213/01.ane.0000220896.56427.53
Olivieri C, Castioni CA, Livigni S, et al. Non‐invasive ventilation after surgery in amyotrophic lateral sclerosis. Acta Neurol Scand 2014; 129: e16–e19. doi: 10.1111/ane.12187.
Russell T, Paul D, Scott-Morgan P, et al. Thriving, not just surviving, with motor neurone disease. The outcome of the first pre-emptive ‘triple-ostomy’. Oxford Med Case Rep 2019: 451–453. doi: 10.1093/omcr/omz109.
Sarna R, Gupta A, Arora G. Amyotrophic lateral sclerosis and anaesthetic challenges: perioperative lignocaine infusion-an aid. Indian J Anaesth 2020; 64: 448–449. doi: 10.4103/ija.IJA_59_20.
Ahn KS, Kopp SL, Watson JC, et al. Postsurgical inflammatory neuropathy. Reg Anesth Pain Med. 2011;36(4):403–405. doi: 10.1097/AAP.0b013e31821e6503
Staff NP, Engelstad J, Klein CJ, et al. Post-surgical inflammatory neuropathy. Brain. 2010;133(10):2866–2880. doi: 10.1093/brain/awq252
Referanslar
Creemers H, Grupstra H, Nollet F, et al. Prognostic factors for the course of functional status of patients with ALS: a systematic review. J Neurol. 2015;262(6):1407–1423. doi: 10.1007/s00415-014-7564-8
Leigh PN, Abrahams S, Al-Chalabi A, et al. the King’s MND care and Research Team. The Management of Motor Neurone Disease. J Neurol Neurosurg Psychiatry. 2003;74 (Suppl IV): 32-47. doi: 10.1136/jnnp.74.suppl_4.iv32
Lechtzin N. Respiratory Effects of Amyotrophic Lateral Sclerosis: Problems and Solutions. Respir Care 2006;51(8):871– 881.
Miller RG, Mitchell JD, Moore DH. Riluzole for amyotrophic lateral sclerosis (ALS)/motor neuron disease (MND). Cochrane Database Syst Rev. 2012;14(3):CD001447. doi: 10.1002/14651858.CD001447
Prabhakar A, Owen CP, Kaye AD. Anesthetic management of the patient with amyotrophic lateral sclerosis. J Anesth. 2013;27(6):909–918. doi: 10.1007/s00540-013-1644-2
Gregory S, Siderowf A, Golaszewski AL, et al. Gastrostomy insertion in ALS patients with low vital capacity: respiratory support and survival. Neurology. 2002;58(5):485-487. doi: 10.1212/wnl.58.3.485.
Hara K, Sakura S, Saito Y, et al. Epidural anesthesia and pulmonary function in a patient with amyotrophic lateral sclerosis. Anesth Analg. 1996;83(4):878-879 doi: 10.1097/00000539-199610000-00040.
Niedermeyer S, Murn M, Choi PJ. Respiratory failure in amyotrophic lateral sclerosis. Chest 2019; 155: 401–408. doi: 10.1016/j.chest.2018.06.035. Epub 2018 Jul 7.
Rafiq MK, Proctor AR, McDermott CJ, et al. Respiratory management of motor neurone disease: a review of current practice and new developments. Pract Neurol 2012; 12: 166 doi: 10.1136/practneurol-2011-000199.
Sachs C, Conradi S, Kaijser L. Autonomic function in amyotrophic lateral sclerosis: a study of cardiovascular responses. Acta Neurol Scand 1985; 71: 373–378. doi: 10.1111/j.1600-0404.1985.tb03215.x.
Murata Y, Harada T, Ishizaki F, et al. An abnormal relationship between blood pressure and pulse rate in amyotrophic lateral sclerosis. Acta Neurol Scand 1997; 96: 118–122 doi: 10.1111/j.1600-0404.1997.tb00251.x.
Lee D, Lee KC, Kim JY, et al. Total intravenous anesthesia without muscle relaxant in a patient with amyotrophic lateral sclerosis. J Anesth. 2008;22(4):443-445. doi: 10.1007/s00540-008-0655-x.
Kimura M, Saito S. Anesthesia for patients with neurological diseases. Masui. 2010; 59(9):1100-1104.
Diefenbach C, Buzello W. Muscle relaxation in patients with neuromuscular diseases. Anaesthesist. 1994;43(5):283-288 doi: 10.1007/s001010050059.
Mashio H, Ito Y, Yanagita Y, et al. Anesthetic management of a patient with amyotrophic lateral sclerosis. Masui. 2000;49(2):191-194
Beach TP, Stone WA, Hamelberg W. Circulatory collapse following succinylcholine: report of a patient with diffuse lower motor neuron disease. Anaesth Analg. 1971;50(3):431-437.
Chang YJ, Jung WS, Son WR, et al. Discordance between train-of-four response and clinical symptoms in a patient with amyotrophic lateral sclerosis. Acta Med Okayama 2014; 68: 125–127. doi: 10.18926/AMO/52409.
Moser B, Lirk P, Lechner M, et al. General anaesthesia in a patient with motor neuron disease. Eur J Anaesthesiol 2004; 21: 921–923. doi: 10.1017/s0265021504250281.
Roberts J, Reddy U. Neuromuscular disorders: relevance to anaesthesia and intensive care. Anaesth Intensive Care Med 2017; 18: 292–295.
Martin-Flores M, Gleed RD, Basher KL, et al. TOF-Watch(R) monitor: failure to calculate the train-of-four ratio in the absence of baseline calibration in anaesthetized dogs. Br J Anaesth 2012; 108: 240–244. doi: 10.1093/bja/aer378.
Racca F, Mongini T, Wolfler A, et al. Recommendations for anesthesia and perioperative management of patients with neuromuscular disorders. Minerva Anestesiologica 2013; 79: 419–433.
Wakimoto M, Nagata H, Kumagai M, et al. [Anesthetic management for a patient with amyotrophic lateral sclerosis; the neuromuscular monitoring was useful to determine appropriate dosages of rocuronium]. Masui 2012; 61: 599–601.
Kelsaka E, Karakaya D, Zengin EC. Use of sugammadex in a patient with amyotrophic lateral sclerosis. Med Princ Practice 2013; 22: 304. doi: 10.1159/000343168.
Nair VP, Hunter JM. Anticholinesterases and anticholinergic drugs. BJA Educ 2004; 4: 164–168.
Bartels K, Hunter JM. Neostigmine versus sugammadex: the tide may be turning, but we still need to navigate the winds. Br J Anaesth 2020; 124: 504–507. doi: 10.1016/j.bja.2020.02.021.
Yoo JH, Kim SI, Park SY, et al. Use of sugammadex in a patient with progressive muscular atrophy and in a patient with amyotrophic lateral sclerosis: Case report. Medicine 2017; 96: e7098–e7098. doi: 10.1097/MD.0000000000007098.
Klemola UM, Menander S, Saarnivaara L. Tracheal intubation without the use of muscle relaxants: remifentanil or alfentanil in combination with propofol. Acta Anaesthesiol Scand 2000;44(4):465-9 doi: 10.1034/j.1399-6576.2000.440419.x.
Erhan E, Ugur G, Alper I, et al. Tracheal intubation without muscle relaxants: remifentanil or alfentanil in combination with propofol. Eur J Anaesthesiol. 2003 Jan;20(1):37-43 doi: 10.1017/s0265021503000073.
Hoeper AM, Barbara DW, Watson JC, et al. Amyotrophic lateral sclerosis and anesthesia: a case series and review of the literature Journal of Anesthesia (2019) 33:257–265 doi: 10.1007/s00540-019-02611-x.
Shemisa K, Kaelber D, Parikh SA, et al. Autonomic etiology of heart block in amyotrophic lateral sclerosis: a case report. J Med Case Rep. 2014;8:224. doi: 10.1186/1752-1947-8-224 doi: 10.1186/1752-1947-8-224.
Hocking G, Wildsmith JA. Intrathecal drug spread. Br J Anaesth. 2004;93(4):568–578. doi: 10.1093/bja/aeh204.
Dripps RD, Vandam LD. Exacerbation of pre-existing neurologic disease after spinal anesthesia. N Engl J Med. 1956;255(18):843–849. doi: 10.1056/NEJM195611012551803
Kane RE. Neurologic deficits following epidural or spinal anesthesia. Anesth Analg. 1981;60(3):150–161. doi: 10.1213/00000539-198103000-00006
Hebl JR, Horlocker TT, Schroeder DR. Neuraxial anesthesia and analgesia in patients with preexisting central nervous system disorders. Anesth Analg. 2006;103(1):223–228. doi: 10.1213/01.ane.0000220896.56427.53
Olivieri C, Castioni CA, Livigni S, et al. Non‐invasive ventilation after surgery in amyotrophic lateral sclerosis. Acta Neurol Scand 2014; 129: e16–e19. doi: 10.1111/ane.12187.
Russell T, Paul D, Scott-Morgan P, et al. Thriving, not just surviving, with motor neurone disease. The outcome of the first pre-emptive ‘triple-ostomy’. Oxford Med Case Rep 2019: 451–453. doi: 10.1093/omcr/omz109.
Sarna R, Gupta A, Arora G. Amyotrophic lateral sclerosis and anaesthetic challenges: perioperative lignocaine infusion-an aid. Indian J Anaesth 2020; 64: 448–449. doi: 10.4103/ija.IJA_59_20.
Ahn KS, Kopp SL, Watson JC, et al. Postsurgical inflammatory neuropathy. Reg Anesth Pain Med. 2011;36(4):403–405. doi: 10.1097/AAP.0b013e31821e6503
Staff NP, Engelstad J, Klein CJ, et al. Post-surgical inflammatory neuropathy. Brain. 2010;133(10):2866–2880. doi: 10.1093/brain/awq252
