title: [Anesthetic management for a patient with amyotrophic lateral sclerosis; the neuromuscular monitoring was useful to determine appropriate dosages of rocuronium].
abstract: We experienced an anesthetic management with rocuronium and neurostimulator for a surgical patient with amyotrophic lateral sclerosis. A 61-year-old man was scheduled for intrathecal baclofen pump implantation as treatment for his spasticity under general anesthesia. After oxygenation and totally intravenous induction with propofol and remifentanil, we administered 10 mg of rocuronium repeatedly monitoring with neurostimulator. When dosage of rocuronium reached 20 mg, train-of-four count reached 1 and his trachea was intubated without coughing or moving. Anesthesia was maintained intravenously. Train-of-four ratio recovered to 95%, 22 minutes after the first administration of rocuronium. Operation was accomplished uneventfully with no additional rocuronium. Bispectral index value recovered to 98 and the patient awoke and breathed spontaneously 19 minutes after termination of administration of anesthetic agents. We could confirm his stable and adequate respiration and trachea was extubated without reversal of rocuronium. In the postanesthesia care unit, he showed no discomfort and was returned to the ward. His symptoms did not deteriorate postoperatively and he was discharged on the 36th postoperative day.
authors: Department of Anesthesiology, School of Medicine, Iwate Medical University, Morioka 020-8505.
authors: Masahiro
authors: M
authors: Wakimoto
authors: Hirofumi
authors: H
authors: Nagata
authors: Motoi
authors: M
authors: Kumagai
authors: Michiko
authors: M
authors: Miyata
authors: Yohko
authors: Y
authors: Iwabuchi
authors: Kenji
authors: K
authors: Suzuki
mesh_terms: D000690:Amyotrophic Lateral Sclerosis / Q000188:drug therapy / Q000601:surgery*; D000732:Androstanols / Q000008:administration & dosage*; D000768:Anesthesia, General; D001418:Baclofen / Q000008:administration & dosage; D006801:Humans; D015918:Infusion Pumps, Implantable; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D009125:Muscle Relaxants, Central / Q000008:administration & dosage; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage*; D000077123:Rocuronium
chemical_list: D000732:Androstanols; D009125:Muscle Relaxants, Central; D003473:Neuromuscular Nondepolarizing Agents; D001418:Baclofen; D000077123:Rocuronium