[Anesthetic management of an ALS patient with remifentanil].

An 82-year-old woman with amyotrophic lateral sclerosis (ALS) with bulbar paralysis, respiratory muscle paralysis, and arteriosclerosis obliterans (ASO) of the lower extremities, underwent uneventful general anesthesia with remifentanil and sevoflurane for bilateral below-knee amputation. Remifentanil is a potent ultra short-acting opioid analgesic drug, undergoes rapid metabolism by non-specific tissue and plasma esterases, and does not accumulate to any clinically important degrees. Furthermore, when remifentanil is used together with propofol during anesthetic induction, successful tracheal intubation can be accomplished without muscle relaxants. These features of remifentanil make it an ideal agent for use in patients with neuromuscular diseases, including ALS, with higher risks of postoperative opioid-induced respiratory depression.