• Raymond P Onders, Arthur M Carlin, MaryJo Elmo, Subhalakashmi Sivashankaran, Bashar Katirji, and Robert Schilz.
• Department of Surgery, University Hospitals Case Medical Center, Detroit, MI, USA. Raymond.onders@uhhospitals.org
• Am. J. Surg. 2009 Mar 1; 197 (3): 386-90.

BackgroundThere 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.MethodThe overall strategy outlined includes the use of rapidly reversible short-acting analgesic and amnestic agents with no neuromuscular relaxants.ResultsFifty-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.ConclusionsLaparoscopic surgery with general anesthesia can be safely performed in patients with ALS undergoing DPS.

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