(Acute inflammatory  polyradiculoneuropathy,  Guillain-Barré polyneuropathy, Landry-Guillain-Barré syndrome, Miller Fisher syndrome)

Acute inflammatory polyradiculoneuropathy secondary to an immune response of T cells directed against the myelin of the spinal roots and peripheral nerves. Progressive symmetrical paresis, possible respiratory failure, swallowing problems. Dysregulation of the autonomic nervous system. Albumino-cytological dissociation of the CSF (normal cells number, hyperalbuminorrhachia). In 50% of cases, a history of recent gram negative bacterial infection, such as Campylobacter jejuni, is found.

Progressive symmetrical ascending paresis typically evolving into 3 phases:

-        extension: rapid onset (a few days to 4 weeks) of muscle weakness of the lower limbs that can lead to complete paralysis, affecting both sides of the body and progressing cephalad to the trunk, upper limbs and sometimes the respiratory  and swallowing muscles;

-        plateau: its duration depends on the severity of the symptoms (the more important the deficits, the longer the plateau phase);

-        recovery: over several weeks, sometimes months, the symptoms disappear in the reverse order of the extension phase.

Anesthetic implications: 

NO succinylcholine; monitoring of the curarization, if necessary. In case of high paralysis: risk of pulmonary inhalations. Hemodynamic instability in case of autonomic dysfunction.

References : 

-         Jones GD, Wilmshurst JM, Sykes K, Murdoch IA. 
Guillain-Barre syndrome: delayed diagnosis following anaesthesia. 
Paediatr Anaesth 1999; 9:539-42.

-         Gipson C, Tobias JD. 
Perioperative care of the chid with Guillain-Barre syndrome. 
Saudi J Anaesth 2008; 2: 67-73.

Updated: April 2019