? anesthesia after Guillan Barre

[dotcb]

Case:

28 yo asymptomtic pregnant female who had Guillan Barre when she was 20 requiring a trach. Patient had a full recovery.

Now patient needs a c-section.

Would you do spinal anesthesia or GA?

Did a little bit of research, which is mostly very conservative and based on very little evidence, suggesting GA is the safer, more conservative approach. But it does seem awfully conservative.

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[2ndyear]

Really should be fine with a spinal. There's a few case reports of worsening with ACTIVE symptoms, and a few that didn't. But those are active. I'd say spinal.

 

[Idiopathic]

i would think any risk of GB recurrence or symptomatic worsening would be less than the airway/aspiration risk in this female (especially one with an old trach and possible complications from that)

 

[Orin]

So just a CA-1, but in my digging through pubmed, this has a section on GBS specifically:

Int Anesthesiol Clin. 2011 Fall;49(4):144-65.
Regional anesthesia in patients with preexisting neuropathy.
Lirk P, Birmingham B, Hogan Q.
Academisch Medisch Centrum, University of Amsterdam, Amsterdam, The Netherlands. http://www.ncbi.nlm.nih.gov/pubmed/21956084

"In patients with residual symptoms of GBS, the safe use of neuraxial blockade has been described using both high and low volumes and doses of LA. The few case reports describing a temporal relationship between RA and the development of GBS do not suffice to classify RA as a risk factor for GBS."

There are quite a few case reports of safe neuraxial anesthesia in patients with active GBS or recurring GBS/CIDP.
http://www.ncbi.nlm.nih.gov/pubmed/17572328
http://www.ncbi.nlm.nih.gov/pubmed/11251144
http://www.ncbi.nlm.nih.gov/pubmed/22179599
There are a few regarding recurrence, but it seems that GBS can recur after surgery regardless of neuraxial anesthesia.

Conceptually, as GBS is a peripheral neuropathy, I would have thought a neuraxial technique would be less risky.