Guillain-Barré Syndrome (GBS)

Succinylcholine is contraindicated - Denervation up-regulates acetylcholine receptors, so succinylcholine can cause hyperkalemic cardiac arrest. Avoid it.

Autonomic instability - Expect exaggerated swings in blood pressure and heart rate and an unpredictable response to vasopressors, laryngoscopy, positioning, and blood loss. Titrate drugs in small increments, keep short-acting agents ready for both hyper- and hypotension, and volume-load cautiously.

Respiratory reserve - Weak respiratory and bulbar muscles mean a real chance of needing postoperative ventilation; track bedside spirometry (forced vital capacity and negative inspiratory force), dose opioids conservatively, and plan monitored recovery.

Nondepolarizing NMB sensitivity - Use reduced doses with quantitative train-of-four (TOF) and confirm full reversal; recovery can be prolonged.

Aspiration risk - Bulbar weakness impairs airway protection; treat as aspiration risk.

Regional and neuraxial - Reasonable to avoid the drug and airway issues of general anesthesia, but document the pre-existing neurologic deficit first and weigh the ongoing autonomic instability.

An acute, immune-mediated demyelinating polyneuropathy, usually following a respiratory or gastrointestinal infection. It produces an ascending flaccid weakness with areflexia that can progress over days to respiratory muscle failure. Two features make it dangerous under anesthesia: autonomic dysfunction - labile blood pressure, tachy- and bradyarrhythmias, and exaggerated responses to position change, blood loss, and vasoactive drugs - and bulbar involvement with a poor cough and high aspiration risk. Recovery occurs over weeks to months but weakness and autonomic instability persist through the acute phase.