Chapter 63 Guillain-Barré Syndrome
9 What considerations regarding anesthesia and neuromuscular blockade should be kept in mind when performing endotracheal intubation in a patient with GBS?
13 Describe the outcome and appropriate timing for transfer out of the intensive care unit
Key Points Guillain-barré syndrome
1. GBS is an acute inflammatory demyelinating polyneuropathy with progressive muscle weakness and areflexia.
2. Cranial neuropathy is often present and may include facial diplegia, ophthalmoplegia, and bulbar symptoms.
3. Symptoms are often preceded by an infectious illness, immunization, or surgery.
4. Respiratory failure and autonomic dysfunction are major complications of GBS.
5. Diagnosis can be confirmed by clinical history, CSF findings showing albuminocytologic dissociation, and nerve conduction studies.
6. Specific therapies includes IVIG and plasmapheresis therapy.
1 Asahina M., Kuwabara S., Suzuki A., et al. Autonomic function in demyelinating and axonal subtypes of Guillain-Barré syndrome. Acta Neurol Scand. 2002;105:44–50.
2 Asbury A.K. Diagnostic considerations in Guillain-Barré syndrome. Ann Neurol 9 Suppl. 1981:1–5.
3 Gorson K.C., Ropper A.H., Muriello M.A., et al. Prospective evaluation of MRI lumbosacral nerve root enhancement in acute Guillain-Barré syndrome. Neurology. 1996;47:813–817.
4 Guillain-Barre Syndrome Steroid Trial Group. Double-blind trial of intravenous methylprednisolone in Guillain-Barré syndrome. Lancet. 1993;341:586–590.
5 Hughes R.A., Hadden R.D., Gregson N.A., et al. Pathogenesis of Guillain-Barré syndrome. J Neuroimmunol. 1999;100:74–97.
6 Hughes R.A., Raphaël J.C., Swan A.V., et al. Intravenous immunoglobulin for Guillain-Barré syndrome. Cochrane Database Syst Rev. 1, 2006. CD002063, 2006
7 Hughes R.A., Wijdicks E.F., Benson E., et al. Supportive care for patients with Guillain-Barré syndrome. Arch Neurol. 2005;62:1194–1198.
8 Kehoe M. Guillain-Barré syndrome—a patient guide and nursing resource. Axone. 2001;22(4):16–24.
9 Lawn N.D., Fletcher D.D., Henderson R.D., et al. Anticipating mechanical ventilation in Guillain-Barré syndrome. Arch Neurol. 2001;58:893–898.
10 Ropper A.H. Further regional variants of acute immune polyneuropathy. Bifacial weakness or sixth nerve paresis with paresthesias, lumbar polyradiculopathy, and ataxia with pharyngeal-cervical-brachial weakness. Arch Neurol. 1994;51:671–675.
11 Ropper A.H., Shahani B.T. Pain in Guillain-Barré syndrome. Arch Neurol. 1984;41:511–514.