Impaired ventilatory capacity after recovery from Guillain-Barré syndrome

A 48-year-old woman who failed to disclose significant past medical history presented for laparoscopic-assisted vaginal hysterectomy with general anesthesia. After the uneventful induction of anesthesia, her trachea could not be intubated due to an extremely anterior larynx, and she was allowed to awaken. However, she developed upper airway obstruction and displayed marked muscle weakness with inadequate tidal volumes and marginal oxygen saturation. A history of prior Guillain-Barré syndrome was disclosed by the attending gynecologist. The patient's recovery was complicated by the development of postobstructive pulmonary edema and by respiratory insufficiency requiring the use of mask continuous positive airway pressure (CPAP). Despite vigorous diuresis, her respiratory status and muscle weakness did not significantly improve until she received a trial of aminophylline by infusion, after which she was able to be weaned from mask CPAP support. The patient was discharged home and returned 8 weeks later for surgery. She underwent awake fiberoptic intubation, after which general anesthesia was induced and maintained without complication. An aminophylline infusion was used in the perioperative period until the patient was successfully awakened and her trachea extubated. The frequency of residual muscle weakness after apparent full recovery from Guillain-Barré syndrome is discussed, along with the rationale for the use of aminophylline in this patient's clinical management.