| Guillain–Barré disease is
a remitting demyelinating disorder of
the peripheral and autonomic nerves. It may be caused by viruses
or vaccinations and follows some bacterial infections. It is usual
to have respiratory tract or gastrointestinal tract infection within
4 weeks of the onset of neurological symptoms. Onset of disease
may be acute, chronic or recurrent.
Symptoms
and signs:
 |
Skeletal
muscle weakness or paralysis. |
| |
Ventilatory
insufficiency. |
| |
Involvement
of cranial nerves. |
| |
Autonomic
nervous system dysfunction:
 |
Significant
hypotension secondary to postural changes, blood loss
or positive airway pressure. |
| |
Fluctuations
of blood pressure and heart rate. |
| |
Cardiac
dysrrhythmias and cardiac arrest. |
| |
Noxious
stimuli (e.g. laryngoscopy, intubation, spinal puncture)
may cause severe hemodynamic instability. |
|
Anesthetic
considerations:
| |
Avoid
the administration of succinylcholine because of risk of severe
hyperkalemia. |
| |
Appropriate
hemodynamic management may necessitate adrenergic blockade
or vasoconstrictors. |
| |
Use
of large doses of local anesthetics for peripheral nerve blocks
may carry a higher risk of toxicity. |
| |
Epidural
opioids may be beneficial
in patients with pronounced sensory disturbances. |
| |
Mechanical
ventilation may be necessary in the postoperative period. |
| |
Serial
measurements of forced vital capacity may be used to follow
staus of ventilatory capacity. |
|