395 posters, 1 audios, 13 topics, 29 sessions, 1,056 authors, 461 institutions
ePostersLive by SciGen Technologies S.A. All rights reserved.
51st Annual Regional Anesthesiology and Acute Pain Medicine Meeting
April 16 - 18, 2026 | Phoenix, Arizona
2292085
A sedation-sparing anesthetic approach for gastrostomy tube placement in an ALS patient with pulmonary compromise
Poster Presenter
Part of Topic
Medically Challenging Cases
A respiration-preserving anesthetic approach for gastrostomy tube placement in an ALS patient with pulmonary compromise
Andrew Monick, MD Montather Taheer, DO Daniel Morgenstern, MD Sally Stander, MD University of North Carolina at Chapel Hill
Patient: 81 years old with amyotrophic lateral sclerosis (ALS). Tachypneic with FVC 40% and dependent on NIPPV. Pleasant, cooperative.
Background: G-tube placement is commonly indicated in ALS patients given progressive dysphagia and concern for aspiration. Ventilatory failure and increased sensitivity to anesthetic medications cause concern for planning.
Anesthetic Interventions:
-
Bilateral rectus sheath blocks (2x 15 cc 0.25% ropivacaine)
-
Left transversus abdominus plane (TAP) block (20 cc 0.25% ropivacaine)
-
0.8 mcg/kg dexmedetomidine
-
SQ local anesthetic at surgical site
Outcome: G-tube was successfully placed. No agents associated with respiratory depression were required.
Regional anesthesia, in conjunction with a sedative that preserves respiratory drive and airway reflexes provides a safe and effective alternative to general anesthesia for G-tube placement among select ALS patients.