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Mechanical Ventilation in the Anesthetized Pediatric Patient
OA-SPA Ask the Expert - September 2024
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Question of the Day
A 58-year-old man is admitted with a one-day history of gradual onset of tingling and weakness in his arms and legs, associated with a lower backache. He has recently returned from a trip abroad, during which time he suffered a self-limiting diarrheal illness. He has no previous medical history and takes no medications. Vital signs include BP 100/60 mmHg, HR 120 bpm, respiratory rate 26/min, SpO2 95% on room air. On clinical examination he appears dyspneic and has symmetrical weakness in the lower > upper extremities. His deep tendon reflexes are absent with down-going plantar reflexes. Which medication is ABSOLUTELY contraindicated in this patient?
Explanation
This patient has a classic presentation for acute inflammatory demyelinating polyneuropathy (AIDP; also known as Guillain-Barre Syndrome). This antibody-mediated acute neuropathic syndrome is frequently incited by a preceding gastrointestinal illness (classically by campylobacter jejuni). Succinylcholine evokes an exaggerated hyperkalemic response in these patients, which can cause cardiac arrest. Nondepolarizing neuromuscular blockers are safe but would be expected to have an exaggerated clinical effect. Finally, the anesthesiologist must be wary of autonomic instability in these patients. Involvement of the autonomic nervous system can cause severe bradycardia, tachycardia, dysrhythmias, and hyper/hypotension. Direct acting autonomic agents such as epinephrine are considered preferable to indirect agents such as ephedrine in these patients.
References:
Kim H, Ryu J, Hwang JW, Do SH. Anesthetic management for cesarean delivery in a Guillain-Barré syndrome patient -A case report-. Korean J Anesthesiol. 2013;64(3):268-271. doi:10.4097/kjae.2013.64.3.268 Bae JS, Yuki N, Kuwabara S, et al. Guillain-Barré syndrome in Asia. J Neurol Neurosurg Psychiatry. 2014;85(8):907-913. doi:10.1136/jnnp-2013-306212 Succinylcholine
OA Series: September 2024
