A respiration-preserving anesthetic approach for gastrostomy tube placement in an ALS patient with pulmonary compromise

Andrew Monick, MD Montather Taheer, DO Daniel Morgenstern, MD Sally Stander, MD University of North Carolina at Chapel Hill

Patient: 81 years old with amyotrophic lateral sclerosis (ALS). Tachypneic with FVC 40% and dependent on NIPPV. Pleasant, cooperative.

Background: G-tube placement is commonly indicated in ALS patients given progressive dysphagia and concern for aspiration. Ventilatory failure and increased sensitivity to anesthetic medications cause concern for planning. 

Anesthetic Interventions:

 

• Bilateral rectus sheath blocks (2x 15 cc 0.25% ropivacaine)

• Left transversus abdominus plane (TAP) block (20 cc 0.25% ropivacaine)

• 0.8 mcg/kg dexmedetomidine

• SQ local anesthetic at surgical site

Outcome: G-tube was successfully placed. No agents associated with respiratory depression were required.