Anesthesia Experience for Guillain-Barre Syndrome in Endoscopy Procedures: A Retrospective Case Series

To determine whether patients with previous Guillain-Barre syndrome (GBS) encountered anesthetic complications that necessitated an unanticipated escalation of care during endoscopic procedures.

We reviewed 309 patients diagnosed with GBS who underwent 537 gastrointestinal endoscopic procedures at all Mayo Clinic geographic sites from January 1, 2012 to May 25, 2023. Our study included patients with GBS from acute onset, chronic/relapsing to full/partial recovery phases. We assessed whether GBS correlated with unanticipated escalations of care, defined as intraprocedural escalation between types of sedation or unanticipated hospital admission after an endoscopic procedure.

No case exhibited anesthesia-related complications or required escalations of care. A total of 85% of cases (458) were performed without a secured airway. Within 6 months of GBS acute onset, 61% of cases (16 of 26) required general endotracheal anesthesia. Nine of 26 acute onset cases involved patients already intubated or with tracheostomies, primarily to place percutaneous endoscopic gastrostomy feeding tubes to advance care outside of the intensive care unit. 33 cases received paralyzing doses of succinylcholine; 3 involved patients with reported residual muscle weakness.

Acute onset GBS cases frequently present with bulbar dysfunction, respiratory distress, and muscle weakness. Patients within 6 months of acute onset should delay elective endoscopic procedures, whereas urgent/emergent ones should be scheduled on a case-by-case basis. Beyond 6 months, most patients exhibit dramatic functional recovery, allowing for administration of sedation without a protected airway. Regardless of time since onset, residual GBS symptoms-particularly respiratory distress and bulbar dysfunction-can help risk stratify patients for periprocedural aspiration risks.