Background
Amyotrophic lateral sclerosis (ALS) is a rare but fatal neurodegenerative disease of the motor neurons that causes muscle weakness, atrophy, and eventually respiratory failure and death. Anesthesia in these patients carries the risk of aspiration, altered response to muscle relaxants and opioids, ventilatory depression, and neurotoxicity to local anesthetics. Thoracic segmental spinal anesthesia may be a viable alternative to general anesthesia in upper abdominal surgeries in ALS patients.
Case presentation
A 38-year-old patient with ALS diagnosed with a left renal mass of mitotic origin was scheduled for radical nephrectomy after an evaluation. Thoracic segmental spinal anesthesia was planned for the patient. The surgery and perioperative period were uneventful, and postoperative analgesic consumption was minimal. The patient was discharged without any progress in his neurodegenerative state.
Conclusions
Our experience with thoracic segmental spinal anesthesia for nephrectomy in this ALS has been satisfactory. Our goals of maintaining hemodynamic stability, avoiding respiratory depression, and limiting further neurological impairment were all achieved. Further studies are needed to establish thoracic segmental spinal anesthesia as a better modality for such cases.