J Dent Anesth Pain Med.  2017 Sep;17(3):235-240. 10.17245/jdapm.2017.17.3.235.

Pulseless electrical activity during general anesthesia induction in patients with amyotrophic lateral sclerosis

• You TM
• Kim S

• KMID: 2390810
• DOI: http://doi.org/10.17245/jdapm.2017.17.3.235

Abstract

Pulseless electrical activity (PEA) is a clinical condition characterized by unresponsiveness and lack of palpable pulse in the presence of organized cardiac electrical activity and is caused by a profound cardiovascular insult (e.g., severe prolonged hypoxia or acidosis, extreme hypovolemia, or flow-restricting pulmonary embolus). Amyotrophic lateral sclerosis (ALS) is a disease that is characterized by progressive degeneration of all levels of the motor nervous system. Damage to the respiratory system and weakness of the muscles may increase the likelihood of an emergency situation occurring in patients with ALS while under general anesthesia. We report a case of PEA during the induction of general anesthesia in a patient with ALS who presented for dental treatment and discuss the causes of PEA and necessary considerations for general anesthesia in patients with ALS.

Keyword

Amyotrophic Lateral Sclerosis; General Anesthesia; Pulseless Electrical Activity

MeSH Terms

Acidosis
Amyotrophic Lateral Sclerosis*
Anesthesia, General*
Anoxia
Emergencies
Humans
Hypovolemia
Muscles
Nervous System
Peas
Respiratory System

Figure

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  Fig. 1 General appearance of the patient with amyotrophic lateral sclerosis. He is unable to walk and requires a wheelchair.

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  Fig. 2 Preoperative radiographic view of patient with amyotrophic lateral sclerosis. (A) Panoramic view, (B) periapical view.

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  Fig. 3 Anesthetic record of patient with amyotrophic lateral sclerosis. The arrow indicates the vital signs when pulseless electrical activity occurs. (A) Oxygen saturation, heart rate, end tidal CO2 volume, and respiration rate, (B) blood pressure.

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