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Caesarean section for a primipara with Guillain-Barré syndrome under combined spinal epidural anaesthesia
  1. Shoko Okahara1,
  2. Ross Bowe1,
  3. Patricia Wong2 and
  4. Mark Johnson1
  1. 1 Department of Anaesthesia and Pain Medicine, Fiona Stanley and Fremantle Hospitals Group, Perth, Western Australia, Australia
  2. 2 Department of Obstetrics and Gynaecology, Fiona Stanley and Fremantle Hospitals Group, Perth, Western Australia, Australia
  1. Correspondence to Dr Shoko Okahara; he216761{at}health.wa.gov.au

Abstract

A primigravida in mid 30s presented to hospital at 30+2 weeks gestation, due to progressive neurological symptoms including ascending limb weakness and paraesthesia bilaterally as well as dysphagia, facial weakness and dysphasia.

The patient was diagnosed with Guillain-Barré syndrome after physical examination and electromyography, which showed a patchy demyelinating sensorimotor polyneuropathy. The patient underwent a 5-day course of intravenous immunoglobulin, beginning the day after admission. Markers of severity including forced vital capacity improved thereafter until delivery.

With limited evidence favouring one particular anaesthetic technique in parturients with Guillain-Barré syndrome, combined spinal epidural anaesthesia was preferred over general anaesthesia in order to avoid the potential for prolonged intubation postoperatively and to allow careful titration of neuraxial blockade. Delivery by caesarean section at 34+1 weeks due to pre-eclampsia was uncomplicated. Thereafter the patient’s condition deteriorated, requiring a further 5-day course of intravenous immunoglobulin with symptoms gradually improving over a 6-month admission.

  • Anaesthesia
  • Pregnancy
  • Neuromuscular disease

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Footnotes

  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: SO and RB. The following authors gave final approval of the manuscript: PW and MJ. Is the patient one of the authors of this manuscript? No.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.