Guillain-Barré syndrome

 

Disease:

Definition

·     AIDP = acute inflammatory demyelinating polyneuropathy

Pathophysiology

·     Immune response

·     Molecular mimicry

·     Ascending and progressive

·     Lower motor neuron weakness

Danger

·     Respiratory insufficiency

o   Mechanical ventilation in 25%

Treatment

·     i.v. Ig

·     Plasma exchange

·     Steroids less helpful

 

Issues:

A

·     Bulbar dysfunction
-> risk of aspiration

B

·     Respiratory insufficiency
-> risk of failed extubation

C

·     Autonomic dysfunction

o   Autonomic hyperreflexia-like

o   Arrhythmias

o   Arrest

D

·     Chronic pain 40-50% / opioids

·     Neuraxial controversial – probably safe

Medications

·     Sux: contraindicated

·     NDMR: sensitivity

 

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