ABSTRACT
A 75-year-old woman with amyotrophic lateral sclerosis (ALS) underwent surgical gastrostomy and repair of incisional hernia. Anesthesia was induced with propofol and high concentrations of sevoflurane. Tracheal intubation was performed without muscle relaxants. Anesthesia was maintained with sevoflurane and thoracic epidural anesthesia (bupivacaine and fentanyl). Surgery, emergence and extubation were completed uneventfully. She was transferred to ICU for postoperative observation. On the 2 nd POD, however, she was re-intubated due to sudden dyspnea and desaturation caused by failed sputum exhaustion. Simultaneously, her ECG showed ischemic change in leads I, III, aVF, and V3-6. Left ventriculogram showed an "Ampulla" or so called "Takotsubo" shape with intact coronary angiogram. After medication with nitroglycerin and diltiazem, her ECG returned to normal. She showed no deterioration of neurological symptoms. No respiratory and cardiac events were reported until her discharge from hospital. We conclude that an extreme care is required in patient with ALS to avoid perioperative complications.
