Administering Anesthesia for Patients with ALS Having a Diaphragmatic Pacemaker Placed: Special Considerations

Amyotrophic lateral sclerosis (ALS) also known as Lou Gehrig’s disease is a relentlessly progressive, fatal disease. Progression of the disease results 3 - 5 years after diagnosis, often from respiratory failure. The diaphragm pacing system (DPS) is a device that stimulates the diaphragm to maximally contract so patients can breathe more effectively. It has been used in patients with neurologic injuries such as spinal cord injury and ALS. From an anesthetic perspective, both the surgery and the patient population present several unique challenges. This case series describes three patients with ALS who had the diaphragmatic pacemaker placed and the anesthetic management during those surgeries.

河南娄氏风湿病学术流派传承与临证经验

河南娄氏风湿病学术流派在130余年的传承发展中,创立了风湿病“虚邪瘀”理论体系。创立者娄宗海因父病而习医,精通岐黄,屡起沉疴,擅长中医内科和妇科疑难杂症。第二代传承人娄孟新尤擅诊治伤寒证、瘟病、痹病、妇科病,名重于时;娄孟林精通中药材炮制技艺,以药济人,知名于时。第三代传承人娄多峰尽得家传,专攻风湿病,创立独具特色的中医风湿病理论体系;娄云峰博学众家,精于医理,名震乡里,以医知名。第四代传承人娄玉钤克绍家学,精通痹证,继承和发展了娄多峰的学术思想;娄高峰擅长运用“虚邪瘀”理论体系诊治类风湿性关节炎、强直性脊柱炎等顽痹。第五代传承人娄玉州精研医理,创业沪上;娄伯恩精于家学,素重医德,辨证精审。河南娄氏风湿病学术流派认为,“虚邪瘀”是导致风湿病的三大核心因素,“虚”指正气亏虚,“邪”指外感之邪,“瘀”指瘀血、痰浊,正虚是内在因素,邪侵是外在条件,“瘀”导致的“不通”是发病关键。在具体的诊治中,注重中医辨病与辨证结合,主张根据患者“虚邪瘀”情况进行综合治疗,强调调摄护理,并归纳总结形成了多个系列治疗风湿病的经验效方如祛风散寒除湿、活血养血通络之通痹汤,清热解毒、疏风除湿、活血通络之清痹汤,活血化瘀、行气通络化瘀之化瘀通痹汤等。