• Skip to primary navigation
  • Skip to main content
  • 786-300-3183
  • [email protected]
  • Facebook
  • Twitter
Florida Society of Anesthesiologists

Florida Society of Anesthesiologists

  • About FSA
    • FSA Leadership
      • Distinguished Service Award Past Recipients
      • President Engagement Award Past Recipients
      • FSA Past Presidents
    • FSA Staff
    • Calendar of Events
    • Contact FSA
    • FSA Charter & Bylaws
    • FSA Speakers Bureau
  • Annual Meeting
    • Meeting Info
    • Call For Abstracts
    • Past Posters
      • 2022 FSA Podium and Poster Abstracts
      • 2021 FSA Posters
      • 2020 FSA Posters
      • 2019 FSA Posters
      • 2018 FSA Posters
    • Past Meetings
      • 2022 Annual Meeting Recap
      • 2019 Annual Meeting Recap
      • 2018 Annual Meeting Recap
  • FSAPAC
    • Donate to FSAPAC
    • FSAPAC Donors for 2022
  • Join/Renew Membership
    • FSA Membership Renewal
    • Join the Florida Society of Anesthesiologists (FSA)
  • Member Login
  • Member Section

2022 FSA Podium and Poster Abstracts

P028: MODIFIED COMBINED SPINAL EPIDURAL ANESTHESIA FOR CESAREAN DELIVERY IN A PATIENT WITH GUILLAIN-BARRé SYNDROME
Alvaro Soto Rincon, MD; Reine Zbeidy, MD; UM/Jackson memorial Hospital

A 38 y/o gravida 2 para 0 at 39 weeks of gestation was transferred to our hospital with progressive ascending muscle weakness. Patient did not have a febrile episode preceding her current neurological deficit. She received her flu vaccine a month ago. Patient describes several weeks of tingling sensation in the bilateral feet and subsequent weakness in the lower extremities along with a burning sensation. She also developed difficulty swallowing and central facial paralysis.

No shortness of breath, bowel/bladder incontinence or autonomic symptoms were reported.

Physical exam showed areflexia and hyporeflexia throughout. Speech was fluent but slightly dysarthric. Facial sensation was intact, but unable to close both eyes, or activate a smile bilaterally. She had decreased muscle strength 3/5, mainly in the lower extremities, and a moderate bilateral upper extremities weakness 4/5. Light touch sensation was preserved, but sensation to pinprick was diminished below mid-thigh, and proprioception was completely abolished.

Preoperative course of the patient included IVIG therapy (2g/5 day) to prevent worsening of the symptoms. A multidisciplinary meeting before surgery included the neurology team, Obstetrics, pediatrics, and anesthesia. Decision for cesarian delivery was made for worsening maternal conditions including hoarseness and dysphonia. She was given antiemetic prophylaxis along with sodium citrate.

Standard ASA monitors were applied. Two intravenous access, and an A-line were placed. A Modified combined spinal epidural was performed in the lateral position at the level of L3-L4, using 1.2 ml of bupivacaine 0.75% with 15 micrograms of fentanyl and 0.1 mg of Duramorph in the intrathecal space. A T6 anesthetic level was slowly built using the epidural catheter to prevent profound hemodynamic changes. Supplemental oxygen was given through a nasal cannula and phenylephrine 20 mcg/min infusion was started to prevent hypotension. Patient remained stable throughout the operation. Estimated blood loss was 600 ml. Apgar scores were 9/9/9.

Post operatively the patient was transferred to ICU for close monitoring. She underwent aggressive physical therapy. She had persistent decreased sensation in bilateral lower extremities and bilateral paraesthesia in upper extremities, and few days later, she developed worsening of the respiratory symptoms and had to be intubated. She was extubated 20 days later.

Currently her motor function is progressively improving, and her speech is back to normal. She is using a walker and continuing her physical rehabilitation therapies.

Copyright © 2023 Florida Society of Anesthesiologists · Managed by BSC Management, Inc.