Combined spinal and epidural anesthesia for labor and cesarean delivery in a patient with Guillain-Barre syndrome.
OBJECTIVE
The anesthetic management of labor, delivery, and cesarean delivery in patients with active or resolving Guillain-Barre syndrome is not well defined. Using a combined spinal and epidural (CSE) technique in such a rare clinical situation has not been previously reported.


METHODS
A 32-year-old woman gravida 2, para 0 was diagnosed with Guillain-Barre syndrome at 21 weeks of pregnancy. Paralysis spread up to the T4 level. Three months later, she was admitted for labor at term. She presented in severe labor pain and it was decided to proceed with CSE analgesia. No unusual hemodynamic instability, signs of autonomic dysfunction, or increased sensitivity to local anesthetics was noted. After several hours, delivery by cesarean section was required and epidural anesthesia was then used. The patient had an uncomplicated postpartum course.


CONCLUSIONS
Careful evaluation and documentation of the patient's baseline neurological status, a thorough discussion with the patient regarding the risks and benefits of the technique for labor analgesia, and an appreciation of the limited experience with this kind of clinical situation are important.
Department of Anesthesiology, The Western Pennsylvania Hospital, Pittsburgh, Pennsylvania, USA.
D V
DV
Vassiliev
E U
EU
Nystrom
C H
CH
Leicht
D000328:Adult; D016362:Analgesia, Obstetrical; D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D019162:Anesthetics, Combined; D002585:Cesarean Section; D005260:Female; D020275:Guillain-Barre Syndrome; D006801:Humans; D007743:Labor, Obstetric; D011247:Pregnancy; D011248:Pregnancy Complications
D019162:Anesthetics, Combined