Anesthetic considerations for laparoscopy for rectal cancer in patient with amyotrophic lateral sclerosis: A case report

Amyotrophic lateral sclerosis, which is also known as motor neuron disease, is a chronic neurodegenerative disease characterized by progressive muscular weakness, respiratory muscle disability, and eventual death. Previous epidemiologic studies have shown no association between cancer and amyotrophic lateral sclerosis. Colorectal cancer arising in patients with amyotrophic lateral sclerosis has rarely been reported. Here, we report a case involving rectal cancer arising in a patient with amyotrophic lateral sclerosis who subsequently underwent curative laparoscopic surgery and adjuvant chemotherapy. Amyotrophic lateral sclerosis causes the deterioration of respiratory function by compromising expiratory and inspiratory muscles; accordingly, patients with amyotrophic lateral sclerosis are at high anesthetic risk, especially with respect to general anesthesia. Careful airway management is essential, and intraoperative neuromuscular monitoring is important. A depolarizing muscle relaxant such as succinylcholine should not be used because of the potential risk of developing hyperkalemia or rhabdomyolysis. Thus, a nondepolarizing muscle relaxant (rocuronium) was used at a low dose in this case. In addition, fentanyl for postoperative patient-controlled analgesia should be used cautiously because fentanyl can cause respiratory muscle rigidity, which may reduce postoperative respiratory function in patients with amyotrophic lateral sclerosis.