title: Anaesthesia for ophthalmologic surgical procedures in a patient with advanced amyotrophic lateral sclerosis: a case report.
abstract: BACKGROUND
  Anaesthesia procedures for surgical interventions in patients with amyotrophic lateral sclerosis (ALS) are not commonly found in clinical practice, and often have special considerations that must be taken into account in treatment planning. As a result, these procedures are rarely subject to publication, rendering it difficult for the anaesthesiologists to find useful and reliable information on this topic. ALS also presents a contraindication to the use of nondepolarising neuromuscular blocking drugs during general anaesthesia.
  
  
  METHODS
  In the case presented here, a 52-year old, White man, the progression of the disease to tetraparesis and respiratory failure, in addition to having the patient on chronic mechanical ventilation support, provided additional challenges to the handling team. The maturation of cataracts severely impaired communication with the patient, and surgical treatment of the cataract presented the only means to save communication. Such interventions are generally performed under local anaesthesia with the advice of the attending anaesthesiologist. However, in this case the patients' announcements during the operation would be unreadable to the advising anaesthesiologist. Here, the authors share experiences from a successfully applied combination of topical and general anaesthesia for two cataract operations and a vitrectomy. This was tolerated well by the patient, and without any side-effects.
  
  
  CONCLUSIONS
  The applied treatment resulted in a substantial improvement of the vision and allowed communication to be maintained with the patient.
authors.affiliation: Department of Cardiac Anaesthesiology, Medical University of Gdañsk, ul, Dêbinki 7, 80-211 Gdañsk, Poland. mkowalik@amg.gda.pl.
authors.forename: Maciej M
authors.initials: MM
authors.lastname: Kowalik
authors.forename: Tomasz
authors.initials: T
authors.lastname: Smiatacz
authors.forename: Robert
authors.initials: R
authors.lastname: Pajuro
authors.forename: Roman
authors.initials: R
authors.lastname: Skowroński
authors.forename: Hanna
authors.initials: H
authors.lastname: Trocha
authors.forename: Walenty
authors.initials: W
authors.lastname: Nyka
authors.forename: Krystyna
authors.initials: K
authors.lastname: Raczyńska
authors.forename: Maria
authors.initials: M
authors.lastname: Wujtewicz