Guillain-Barre Syndrome in a Patient Posted for Elective Caesarean Delivery: An Anaesthetic Dilemma

Abstract

Guillain-Barre syndrome (GBS) is an acute polyneuropathy most commonly associated with acute flaccid paralysis which may be associated with sensory and autonomic neuropathy. Antecedent infection may trigger an immune response which may cause a cross reaction leading to demyelination and degeneration of axons in nerves. Here we present a case of a 28 year old female, G2P1 at 37 weeks of gestation with a history of previous lower segment caesarean section (LSCS) and oligohydramnios with suspected Guillain-Barre syndrome posted for elective LSCS. She presented with dribbling of saliva from angle of mouth and inability to close both eyes with slurring of speech since 2 days. MRI brain was advised which showed no specific changes. Neurology evaluation was done and Guillain-Barre syndrome with isolated facial diplegia was suspected. Due to risks associated with general anaesthesia and succinylcholine in this patient, a decision was made to proceed with a low dose spinal anaesthesia. Once administered, the level of subarachnoid block was noted to be at T6. The caesarean section proceeded uneventfully with no major hemodynamic changes. A healthy baby girl was delivered and patient was noted to have full motor and sensory recovery in the post-operative period. Providing anaesthesia to patients with Guillain-Barre syndrome can be very challenging. Meticulous pre-anaesthetic planning is needed. A thorough pre-anaesthetic evaluation considering risks and benefits of each modality of anaesthesia is crucial before anaesthetizing these patients.