Abstract
Introduction: Guillain Barre Syndrome in pregnant ladies, undergoing cesarean section, has not yet reported in Nepal. Anaesthetic management of 15 patients with Guillain Barre Syndrome who underwent lower segment cesarean section at Nobel Medical College Teaching Hospital is reported here.
 Objective: The purpose of this study is to assess the benefits of Rectus sheath nerve block along with infiltration of retropubic space of Retzius in Guillain Barre syndrome patients planned for lower segment cesarean section (LSCS).
 Methodology: During the period from 1st August 2015 to 31st April 2020 at NMCTH, a retrospective descriptive analysis of 15 pregnant ladies with Guillain Barre Syndrome who underwent lower segment cesarean section under Rectus sheath nerve block along with Retro pubic space of Retzius, infiltration and visceral peritoneum infiltration is discussed.
 Result: Considering Surgeons opinion about the operating conditions like Relaxation, Straining, Coughing, Bucking, Satisfactory to good operative conditions were reported. Excellent to good satisfaction was expressed by 39.9% of patients, 60% patients reported satisfactory. Hypotension and Arrhythmias was seen in 2 patients. Diaphoresis was seen in 1 patient. Fetomaternal outcome was good. There was no mortality.
 Conclusion: Rectus sheath block along with infiltration of retro pubic space of Retzius block can be considered as a good alternative to general anaesthesia or neuraxial block incase where general anesthesia & neuraxial block is risky or contraindicated for lower segment cesarean section in patients with Guillain Barre Syndrome.
Highlights
Guillain Barre Syndrome (GBS), known as Acute idiopathic polyneuri s is considered to be a collec on of diverse disorders with several clinical manifesta ons, and not as it was first described,“syndrome of symmetric rapidly progressing flaccid paralysis and a reflexia”.1,2 Mostly it is characterized by the sudden onset of weakness or paralysis that typically manifests in the legs and spreads cephalad and involves skeletal muscles of the arms, trunk and head
A sodium channel blocking factor has been detected in the cerebrospinal fluid (CSF) of pa ents with Guillain Barre Syndrome which according to many could contribute to the paralysis.[7,8,9]
During the period from 1st August 2015 to 31st April 2020, pregnant ladies with Guillain Barre Syndrome (GBS) reported to opera on theatre of Nobel Medical College Teaching Hospital for lower segment cesarean sec on (LSCS) under Rectus sheath nerve block with infiltra on of retropubic space of retzius has been done to evaluate the complica ons and whether there are any benefits of these technique compared with the published results of conven onal spinal anaesthesia for such pa ents as reported in the literature
Summary
Guillain Barre Syndrome (GBS), known as Acute idiopathic polyneuri s is considered to be a collec on of diverse disorders with several clinical manifesta ons, and not as it was first described,-“syndrome of symmetric rapidly progressing flaccid paralysis and a reflexia”.1,2 Mostly it is characterized by the sudden onset of weakness or paralysis that typically manifests in the legs and spreads cephalad and involves skeletal muscles of the arms, trunk and head. Guillain Barre Syndrome (GBS), known as Acute idiopathic polyneuri s is considered to be a collec on of diverse disorders with several clinical manifesta ons, and not as it was first described,-“syndrome of symmetric rapidly progressing flaccid paralysis and a reflexia”.1,2 It is characterized by the sudden onset of weakness or paralysis that typically manifests in the legs and spreads cephalad and involves skeletal muscles of the arms, trunk and head. Backache and tenderness of skeletal muscles on deep pressure is a common accompaniment.[4] More than 60% of pa ents develop autonomic nervous system dysfunc ons which is the most prominent cause of catastrophic in such pa ents par cularly in those undergoing anaesthesia and surgery This is because of wide fluctua on of blood pressure, sudden profuse diaphoresis, peripheral vasoconstric on, res ng tachycardia, sudden severe orthosta c hypotension and cardiac conduc on abnormali es leading to sudden cardiac arrest.[5] Such pa ents exhibit an exaggerated response to sympathomime cs. The an gens secreted by these pathogens target the nerve fibers by ini a ng an immune response.[3,5,6,7,8,9]
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