2024 FSA Podium and Poster Abstracts

P089: HISTORY OF GUILLAIN-BARRE SYNDROME, LABOR EPIDURAL, AND INFORMED ANESTHETIC CONSENT
Seongmin Lee, MD; Pavan Vemula, MD; Mirsad Dupanovic, MD; HCA Florida Oak Hill Hospital

Introduction/Background: Guillain-Barre syndrome (GBS) is a neurologic disorder characterized by rapid-onset ascending muscle weakness of unknown etiology. Some reports have noted GBS following epidural anesthesia. Thus, it is the responsibility of anesthesia providers to disclose and discuss all relevant information with the patient before arriving at a clinical decision about an epidural.

Methods: This report highlights a term 24-year-old G1P0 parturient with mild sequelae of Charcot-Marie disease and a previous acute episode of Guillain-Barre Syndrome (GBS). The patient requested epidural analgesia. Potential neurologic risks were explained and remifentanil patient-controlled analgesia was offered. It was refused because of intolerance of opioids. Then the patient was given the following keywords: “epidural, GBS, complications” and asked to conduct an online search for additional information to come to a better-informed final decision. After a two-hour long review with her family, the patient opted for an epidural. A baseline bilateral lower extremity sensation, foot dorsi-flexion/plantar-flexion, knee flexion/extension were measured. A lumbar epidural was placed on the first attempt at L3-L4 with Touhy needle (17GX3.5”) and 1.5 mL test-dose of 1.5% lidocaine administered. A 5 mL initial bolus of mixture of 0.2% Ropivacaine/2 mcg Fentanyl followed a few minutes later, and finally a 10 mL/hr infusion of the same solution was started.

Results: Repeat assessments performed throughout the labor demonstrated no unexpected findings. The patient had an uncomplicated overnight vaginal delivery. There were no new neurologic deficits after catheter removal the next day. She denied any lower extremity weakness, sensory deficits, or paresthesia during a one week and one month follow-up via phone call.

Discussion/Conclusion: A clear relationship between GBS and epidural remains to be established. Some reports have highlighted uneventful epidural anesthesia in patients with active GBS or history of GBS. Contrary to that, GBS has been reported in healthy patients following epidural anesthesia. Thus, anesthesia providers may be reluctant to provide labor epidural analgesia to these patients. On the other hand, treating labor pain is one of the primary responsibilities of an obstetric anesthesia provider. Therefore, an informed anesthesia consent, in which the patient is an active participant and is encouraged to use all available resources, should have a critical role in decision making. This report presents a case of a successful labor epidural for a patient with prior GBS and it exemplifies the utilization of online resources to better educate patients and give them full autonomy in making these important decisions at the time of significant stress.