Surgery in a patient with amyotrophic lateral sclerosis (ALS) should be performed with caution and careful preparations. It often requires a multi-disciplinary approach.


Patient selection: amyotrophic lateral sclerosis (ALS)


Risks posed by surgery:

(1) adverse effects of medications

(2) respiratory failure

(3) sudden death

(4) interactions with drugs used to manage the ALS

(5) postoperative frailty


Use of depolarizing agents for neuromuscular blockade is contraindicated. These drugs can cause:

(1) rhabdomyolysis

(2) muscle spasm

(3) rhabdomyolysis


Drugs that must be used with caution or avoided:

(1) non-depolarizing neuromuscular blockers

(2) halogenated volatile anaesthesia

(3) aminoglycoside antibiotics

(4) opioids


Conditions that should be avoided:

(1) hypocalcemia

(2) hypermagnesemia

(3) acidosis

(4) hypothermia

(5) hypercapnia


Respiratory problems:

(1) inability to clear secretions

(2) respiratory muscle fatigue

(3) central respiratory depression

(4) aspiration

(5) impaired cough

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