Journal
AMERICAN JOURNAL OF SURGERY
Volume 197, Issue 3, Pages 386-389Publisher
EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
DOI: 10.1016/j.amjsurg.2008.11.008
Keywords
Amyotrophic lateral sclerosis; Diaphragm pacing; Perioperative management
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BACKGROUND: There is a paucity of literature concerning general anesthesia and surgery in patients with amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease). This report summarizes the largest series of surgical cases in ALS during multicenter prospective trials of the laparoscopic diaphragm pacing system (DPS) to delay respiratory failure. METHOD: The overall strategy outlined includes the use of rapidly reversible short-acting analgesic and amnestic agents with no neuromuscular relaxants. RESULTS: Fifty-one patients were implanted from March 2005 to March 2008 at 2 sites. Age at implantation ranged from 42 to 73 years and the percent predicted forced vital capacity (FVC) ranged from 20% to 87%. On preoperative blood gases, P-CO2 was as high as 60. Using this protocol, there were no failures to extubate or 30-day mortalities. The DPS system increases the respiratory system compliance by decreasing posterior lobe atelectasis and can stimulate respirations at the end of each case. CONCLUSIONS: Laparoscopic surgery with general anesthesia can be safely performed in patients with ALS undergoing DPS. (c) 2009 Published by Elsevier Inc.
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