Emergency Caesarean Delivery in a Pregnant Woman with Guillain–Barré Syndrome: A Case Report of Anesthetic Challenges and Management
Year: 2026
Type: article
Study design: Case Report
Abstract: Background: Guillain–Barré syndrome (GBS) presents important anesthetic challenges during pregnancy because of potential respiratory weakness, autonomic instability, and altered responses to neuromuscular-blocking agents. We report the anesthetic management of a pregnant woman with GBS undergoing emergency caesarean delivery. Case Summary: A 32-year-old gravida 4 para 2 woman at 33 weeks of gestation, with two previous caesarean deliveries, was diagnosed with GBS after progressive bilateral lower-limb weakness supported by nerve-conduction studies. Despite five sessions of plasmapheresis, ambulation remained markedly impaired. Preoperatively, lower-limb power was 3/5 proximally and 2/5 distally, with no bulbar involvement, respiratory compromise, or clinically apparent autonomic instability. Umbilical artery Doppler demonstrated absent end-diastolic flow, prompting emergency repeat caesarean delivery. Following multidisciplinary discussion, general anesthesia was selected because postoperative worsening of pre-existing weakness after neuraxial anesthesia could create diagnostic uncertainty. Anesthesia was induced with intravenous propofol 2–3 mg/kg. Succinylcholine was avoided because of the risk of severe hyperkaliemia in patients with GBS. Atracurium was withheld during induction and subsequently administered at 0.1 mg/kg in two to three small incremental doses during maintenance. The patient remained hemodynamically and respirat¬orily stable throughout surgery. A live neonate was delivered with Apgar scores of 7 and 10 at 1 and 5 minutes, respectively. Neuromuscular blockade was reversed with neostigmine 0.05 mg/kg and glycopyrrolate. She was extubated and monitored in the intensive care unit for 6–8 hours without complications. Conclusion: Anesthetic management for caesarean delivery in pregnant patients with GBS should be individualized according to neurological, respiratory, and autonomic status. When general anesthesia is selected, avoidance of succinylcholine, cautious titration of non-depolarizing neuromuscular blockade, and close postoperative monitoring are important considerations. Key Words: Emergency Cesarean Delivery, Guillian-Barre Syndrome, Anesthesia.
Source: Journal of Saidu Medical College
Authors: Zia Ullah, Kisa Fatima, Misbah Batool, Mariam Murtaza, Zain Ul Abedeen
Subfield: Anesthesiology and Pain Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7213413854
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