Total intravenous anesthesia without neuromuscular blockers for ureteral lithotripsy in an ALS patient with orthopnea: a case report

Patients with amyotrophic lateral sclerosis (ALS) rarely need urological surgery. This case report describes the successful use of total intravenous anesthesia (TIVA) with propofol and remifentanil combined with laryngeal mask airway (LMA) ventilation in a 55-year-old ALS patient with severe orthopnea who underwent ureteral lithotripsy. Given the progressive respiratory muscle weakness and inability to tolerate supine positioning, a tailored anesthetic approach is imperative. By avoiding neuromuscular blockers and minimizing opioid doses, we aimed to reduce postoperative respiratory depression. The procedure was completed uneventfully, with stable hemodynamics and rapid postoperative recovery. This case underscores the importance of individualized anesthetic strategies in neuromuscular disorders to optimize safety and outcomes.