Amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis

Other names	ALS
Anesthetic relevance	Low
Anesthetic management	- No specific anesthetic drugs are best for this disease - Succinylcholine may cause hyperkalemia due to LMN disease - Non-depolarizing NMDs may be prolonged - Bulbar involvement may increase aspiration risk
Specialty	Neurology
Signs and symptoms
Diagnosis	Based upon clinical signs and symptoms
Treatment
Article quality
Editor rating	In development
User likes	0

Provide a brief summary of this comorbidity here.

Anesthetic implications

Intraoperative management

• No ideal anesthesia for this condition
• Take caution with succinylcholine administration as the LMN disease may incite hyperkalemia after administration
• Non-depolarizing neuromuscular blockers may be prolonged
• Take caution with regional anesthesia, although it is not contraindicated
• Neuraxial:
  • Benefits: decreased chance of prolonged intubation secondary to bulbar weakness
  • Risks: Increased risk of worsening neurologic condition postoperatively, risk of sympathectomy resulting in vasodilation and hypotension, high spinal presents risk of bradycardia, worsening hypotension, cardiovascular collapse.
• General anesthesia: Increased risk of prolonged intubation secondary to bulbar weakness

Pathophysiology

• Progressive upper and lower motor neuron degeneration

Signs and symptoms

• Skeletal muscle weakness
• Atrophy of thenar eminences

Epidemiology

Affects men between the ages of 40-60