Guillain-Barre Syndrome (GBS)
Background
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Acute inflammatory demyelinating peripheral polyneuropathy usually secondary to immunologic response to viral or bacterial infection
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Ascending progressive muscle weakness, autonomic dysfunction & areflexia
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Respiratory compromise:
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25% will require mechanical ventilation
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Forced vital capacity < 20 mL/kg, maximum inspiratory pressure < 30 cmH2O, or maximum expiratory pressure < 40 cmH2O → high risk of impending respiratory failure, urgent intubation & mechanical ventilation
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Considerations
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Aspiration risk due to to bulbar dysfunction
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Perioperative respiratory insufficiency due to muscle weakness (anticipate need for postoperative ventilation)
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Autonomic dysfunction with possible hemodynamic instability & autonomic hyperreflexia type reactions:
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Arrhythmias, cardiac arrest
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Physical stimulation can precipitate hypertension & tachycardia
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Altered response to neuromuscular blocking drugs (NMBs):
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Succinylcholine contraindicated due to hyperkalemia risk
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NdMR (nondepolarizing muscle relaxant) sensitivity
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↑ risk of venous thromboembolism
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Neuropathic pain common (40-50%)
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Treatment includes IVIG & plasma exchange, steroids NOT recommended
Goals
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Minimize aspiration risk (consider prophylaxis, RSI)
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Maximize respiratory function (avoid NMBs or reduced dose of NdMR & full reversal, secretions, pain management)
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Maintain hemodynamic stability
Conflicts
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RSI vs avoid succinylcholine, hemodynamic stability
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Neurologic deficits & regional techniques
Pregnancy Considerations
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Controversy regarding neuraxial but probabaly safe, document pre-existing deficits
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If general anesthetic chosen: avoid succinylchonline & avoid or use minimal NdMR