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Journal of Obstrectic Anaesthesia and Critical Care
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LETTER TO EDITOR
Year : 2020  |  Volume : 10  |  Issue : 1  |  Page : 61-62

Epidural anaesthesia in a parturient with guillain–barre syndrome


Department of Anaesthesiology and Critical Care, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India

Date of Submission26-Dec-2019
Date of Acceptance27-Jan-2020
Date of Web Publication11-Mar-2020

Correspondence Address:
Dr. Y S Ranjitha
D/O Subramanyam #182, Shantamandira, 2nd Floor, 9th Cross, HMT Layout, R.T Nagar Post, Bengaluru -560 032, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joacc.JOACC_59_19

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How to cite this article:
Oak S, Hemantkumar I, Chaskar V, Ranjitha Y S. Epidural anaesthesia in a parturient with guillain–barre syndrome. J Obstet Anaesth Crit Care 2020;10:61-2

How to cite this URL:
Oak S, Hemantkumar I, Chaskar V, Ranjitha Y S. Epidural anaesthesia in a parturient with guillain–barre syndrome. J Obstet Anaesth Crit Care [serial online] 2020 [cited 2020 May 30];10:61-2. Available from: http://www.joacc.com/text.asp?2020/10/1/61/280369



Dear Sir,

The choice of anesthesia in parturients with Guillain–Barre Syndrome is difficult as they have weakness of limbs due to involvement of nerves which may progress to respiratory paralysis. So, general anesthesia was the technique of choice in these patients. Recently, there has been an increase in interest in the administration of neuraxial anesthesia in the form of epidural and spinal anesthesia in these patients. The technique of epidural anesthesia is safer as the extent of block could be diligently extended so as to avoid sudden hemodynamic changes and respiratory compromise. We report a case of a parturient with GBS who presented to us for cesarean section. Epidural anesthesia was administered with 0.375% bupivacaine (lesser than the routinely used anesthetic concentration).

A 25-year-old parturient, G3P2 was diagnosed to have GBS and was referred to us for elective cesarean at 38 weeks of gestation. GBS was diagnosed during her 7th month of gestation when she had gradual progressive weakness of all four limbs and dyspnoea. She was admitted in intensive care unit and required ventilatory support and intravenous immunoglobulin. Ultrasound of fetus showed normal fetal cardiac activity. She was gradually weaned off from ventilatory support and discharged after 25 days of intensive care without any residual weakness or difficulty in breathing. Decision was taken to carry out the cesarean section under epidural anesthesia. Under all aseptic precautions, epidural catheter was inserted in T12-L1 interspace with 18G Tuohy's needle. Epidural test dose of 45 mg lignocaine and 15 mcg of adrenaline was administered. After 10 minutes, 14 cc of 0.375% bupivacaine (lesser than routinely used 0.5% bupivacaine as anesthetic concentration) and 20 mcg of fentanyl were given through epidural catheter in graded doses of 8 ml followed by 6 ml after 40 minutes of the initial 8 ml dose. The epidural block was established till T8 dermatomal level. There were no episodes of hypotension, bradycardia or dyspnoea throughout the surgery. 90 micrograms of Buprenorphine was given through epidural catheter at an interval of 12 hours for postoperative analgesia. Since she did not develop weakness/sensory disturbance/respiratory compromise, she was discharged on the 8th day after surgery.

As GBS patients have greater sensitivity to local anesthetics,[1] sudden hemodynamic changes in the form of profound hypotension, bradycardia, and cardiovascular collapse may occur after spinal anesthesia. Also, postoperative neurodeficit is a feared complication of subarachnoid block due to increased sensitivity to local anesthetic agents, interaction between local anesthetics, and myelin and direct damage to nerve roots.[2] Pregnancy necessitates rapid sequence induction if general anesthesia is administered. Succinyl choline must be avoided as it leads to hyperkalemia.[3] As GBS is a demyelinating polyradiculoneuritis, sensitivity to non-depolarizing muscle relaxants increases as well; this might result in delayed recovery and postoperative ventilatory support.[4] From this case, we infer that epidural anesthesia with 0.375% bupivacaine would be a more logical choice in a parturient with GBS presenting for elective cesarean section as it is associated with less cardiovascular and respiratory repercussions.

The case described here is a representative case and further studies may be required to prove the safety profile of epidural anesthesia in GBS.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Perel A, Reches A, Davidson JT. Anaesthesia in the Guillain-Barré syndrome: A case report and recommendations. Anaesthesia 1977;32:257-60.  Back to cited text no. 1
    
2.
Mangar D, Sprenker C, Karlnoski R, Puri S, Decker D, Camporesi E. Rapid onset of Guillain-Barré syndrome after an obstetric epidural block. A&A Practice 2013;1:19-22.  Back to cited text no. 2
    
3.
Kocabas S, Karaman S, Firat V, Bademkiran F. Anesthetic management of Guillain-Barré syndrome in pregnancy. J Clin Anesth 2007;19:299-302.  Back to cited text no. 3
    
4.
Brooks H, Christian AS, May AE. Pregnancy, anaesthesia and Guillain Barre syndrome. Anaesthesia 2000;55:894-8.  Back to cited text no. 4
    




 

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