Guillain-Barre Syndrome (GBS)

 

 

Background 

 

  • Acute inflammatory demyelinating peripheral polyneuropathy usually secondary to immunologic response to viral or bacterial infection

  • Ascending progressive muscle weakness, autonomic dysfunction & areflexia

  • Respiratory compromise:

    • 25% will require mechanical ventilation 

    • 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

 

 

Considerations 

 

  • Aspiration risk due to to bulbar dysfunction

  • Perioperative respiratory insufficiency due to muscle weakness (anticipate need for postoperative ventilation)

  • Autonomic dysfunction with possible hemodynamic instability & autonomic hyperreflexia type reactions:

    • Arrhythmias, cardiac arrest

    • Physical stimulation can precipitate hypertension & tachycardia 

  • Altered response to neuromuscular blocking drugs (NMBs):

    • Succinylcholine contraindicated due to hyperkalemia risk

    • NdMR (nondepolarizing muscle relaxant) sensitivity

  • ↑ risk of venous thromboembolism

  • Neuropathic pain common (40-50%) 

  • Treatment includes IVIG & plasma exchange, steroids NOT recommended

 

 

Goals 

 

  • Minimize aspiration risk (consider prophylaxis, RSI)

  • Maximize respiratory function (avoid NMBs or reduced dose of NdMR & full reversal, secretions, pain management)

  • Maintain hemodynamic stability

 

 

Conflicts 

 

  • RSI vs avoid succinylcholine, hemodynamic stability

  • Neurologic deficits & regional techniques

 

 

Pregnancy Considerations 

 

  • Controversy regarding neuraxial but probabaly safe, document pre-existing deficits 

  • If general anesthetic chosen: avoid succinylchonline & avoid or use minimal NdMR

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