@article{oai:redcross.repo.nii.ac.jp:02001546,
 author = {安部, 桂 and 清水,  一郎 and 武智,  健一 and 安部, 俊吾 and 彭, 懌 and 伊東, 真理},
 issue = {1},
 journal = {松山赤十字病院医学雑誌, The Matsuyama Red Cross Hospital Journal of Medicine},
 month = {Dec},
 note = {筋萎縮性側索硬化症（Amyotrophic lateral sclerosis : ALS）は，上位下位運動ニューロンの変性により全身の筋萎縮，筋力低下を生じ呼吸筋麻痺による呼吸不全となる稀な神経変性疾患である．ALSを合併した患者に対する周術期管理では呼吸器合併症や呼吸機能低下を防ぐことが求められる．
今回我々は ALS の患者に対する開腹腸瘻造設術に対し，全身麻酔に併用して術前に単回の腹直筋鞘ブロック（Rectus sheath block : RSB）を行い，術後にカテーテルを留置し持続腹直筋鞘ブロックを行うことで術中の筋弛緩薬，オピオイドの使用量を抑え，術後痛を管理することを計画した．ALS 患者に対する区域麻酔併用全身麻酔の利点と問題点につ
いて文献的考察を加え報告する．本症例報告にあたっては患者本人に文書による承諾を得た, Amyotrophic lateral sclerosis（ALS）is a rare neurodegenerative disease that affects the upper and lower motor neurons and eventually causes, systemic muscle atrophy, paralysis, and bulbar paralysis. Furthermore, weakness of the respiratory muscles leads to respiratory failure and death. The perioperative management of patients with ALS requires the prevention of respiratory complications and avoidance of decline in respiratory function. We performed general anesthesia with rectus sheath block（RSB）to create an open jejunostomy in patients with ALS. Thereby, we managed the perioperative period without any respiratory complications. In this report, we discuss the benefits and problems of general anesthesia with regional anesthesia for patients with ALS complications, along with discussing the existing literature. The current patient had dysphagia, difficulty in excreting sputum, and severe dyspnea, and thus was considered to be at a high risk of developing respiratory complications. Choosing muscle relaxants, opioids, spinal trunk anesthesia, or peripheral nerve block is challenging. Particularly,
the use of nondepolarizing muscle relaxants in ALS is often discouraged due to increased sensitivity to muscle relaxants, uncertainty of muscle relaxation monitoring, and reports of recurarization after sugammadex reversal. Additionally, postoperative analgesia should be considered, due to concerns regarding opioid-induced respiratory depression and delayed recovery of spontaneous respiration. We performed a single RSB preoperatively to achieve intraoperative muscle relaxation. Thereafter, we inserted a catheter for continuous RSB for postoperative analgesia. We noted that intraoperative use of muscle relaxants and opioids could be reduced, and postoperative analgesia was achieved at rest. However, the effects of either of these alone were insufficient. There are limitations regarding the types and doses of medications that can be safely used in ALS, since the progression of the disease and the degree of decline in respiratory function can vary in ALS. Careful perioperative management and collaboration with surgeons is required, considering each patientʼs condition and surgical invasiveness. Using RSB for  multimodal anesthesia and postoperative management may be an effective tool in this regard.},
 pages = {35--39},
 title = {筋萎縮性側索硬化患者の開腹腸瘻造設術に対し 腹直筋鞘ブロックを行った一例},
 volume = {48},
 year = {2023}
}