title: Amyotrophic lateral sclerosis: the Midwestern surgical experience with the diaphragm pacing stimulation system shows that general anesthesia can be safely performed.
abstract: 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.
  
  
  METHODS
  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, Pco(2) 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.
authors.affiliation: Department of Surgery, University Hospitals Case Medical Center, Detroit, MI, USA. Raymond.onders@uhhospitals.org
authors.forename: Raymond P
authors.initials: RP
authors.lastname: Onders
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Carlin
authors.forename: MaryJo
authors.initials: M
authors.lastname: Elmo
authors.forename: Subhalakashmi
authors.initials: S
authors.lastname: Sivashankaran
authors.forename: Bashar
authors.initials: B
authors.lastname: Katirji
authors.forename: Robert
authors.initials: R
authors.lastname: Schilz
mesh_terms: D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications*; D000768:Anesthesia, General; D003964:Diaphragm / Q000294:innervation; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012133:Respiratory Paralysis / Q000209:etiology / Q000628:therapy*