No abstract

Gullain Barre Syndrome (GBS) is an acute inflammatory demyelinating polyradiculopathy of rare occurrence in pregnancy. We report a case of a 36 weeks pregnant patient posted for emergency Caesarean section for foetal distress. At 28weeks of pregnancy the patient was diagnosed with GBS for which she was intubated and was on mechanical ventilation for 19 days. Subsequently she was extubated and discharged after 36 days. During this period, she received treatment with intravenous immunoglobulins and plasmapheresis. The patient continued to have weakness of both lower limbs and bladder incontinence prior to surgery. General anaesthesia was administered to the patient keeping in view the autonomic system involvement in the disease and presence of foetal distress. The intraoperative course was smooth and patient was extubated uneventfully. Keywords: Gullain Barre Syndrome, Pregnancy, Autonomic dysfunction, General anaesthesia, Emergency caesarean section

Plateau pressure and peak airway pressure are directly related to the poor outcome of ventilator supported patients. Monitoring of these parameters helps clinicians in early identification of impending mortality and initiation of measures to prevent the same. This is a retrospective study in which 100 patients who were on ventilator support for >24 hours and died there after were studied. Here patient’s ventilatory parameters like plateau pressure and peak airway pressure were collected at base line, 1 hour, 30 min, 15 min, 5 min prior to cardiac arrest. Other ventilatory parameters like tidal volume and positive end expiratory pressure (PEEP) were also collected. In all the studied patients plateau pressure and peak airway pressure at 1hour, 30min, 15min, and 5min prior to cardiac arrest were high compared to base line values. These values were statistically significant as ‘P’ value was < 0.05. We conclude that a continuous, sustained rise in plateau and peak airway pressure above the baseline is useful in predicting mortality in mechanically ventilated patients.