Successful Caesarean Section under Spinal Anaesthesia in a Pregnant Woman with Guillain–Barré Syndrome: A Case Report from a Resource-Limited Setting

Successful Caesarean Section under Spinal Anaesthesia in a Pregnant Woman with Guillain–Barré Syndrome: A Case Report from a Resource-Limited Setting | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Successful Caesarean Section under Spinal Anaesthesia in a Pregnant Woman with Guillain–Barré Syndrome: A Case Report from a Resource-Limited Setting Shilpa A NAIK, Prathvi B, Ranjan R K This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8927026/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Guillain-Barre syndrome (GBS) is a rare but serious neurological condition due to autonomic instability, decreased respiratory function, and unpredictable medication responses, which can make pregnancy difficult and provide considerable anaesthetic issues. We report the case of a 23-year-old primigravida at 33 weeks of gestation who developed acute motor–sensory neuropathy consistent with GBS and subsequently required emergency caesarean delivery. In a remote healthcare setting with limited airway and ventilatory resources, spinal anaesthesia was chosen after a multidisciplinary evaluation as the patient had stable respiratory function, with no bulbar involvement, and a potentially difficult airway. The intraoperative and postoperative periods were uneventful, and no neurological deterioration was observed. This case shows that, in certain GBS parturients, spinal anaesthesia can be a safe substitute for general anaesthesia, especially in settings with limited resources. Additionally, it emphasises the management of neuromuscular illness in high-risk obstetric patients by coordinated decision-making, meticulous monitoring, and individualized assessment. Caesarean section Guillain–Barre syndrome (GBS) spinal anaesthesia parturient regional anaesthesia resource-limited setup INTRODUCTION Acute autoimmune neuropathy, Guillain-Barre syndrome (GBS), usually manifests as increasing weakness, decreased reflexes, and varied degrees of autonomic dysfunction. Even though it is uncommon, Guillain-Barré syndrome during pregnancy poses a challenging clinical problem since its neurological symptoms might resemble or overlap with the typical physiological changes that occur throughout gestation. Significant immunological changes are also associated with pregnancy, including a rebound in cell-mediated immunity during the postpartum phase and a shift towards humoral immunity in late gestation. The start or worsening of immune-mediated conditions like GBS in the third trimester or the early postpartum phase may be exacerbated by these alterations. 1 , 2 Pregnancy-related physiological changes in the mother, such as decreased respiratory reserve, increased oxygen consumption, increased susceptibility to positional hypotension, and higher circulatory demands, can enhance the unpredictability of GBS progression. Ventilation may be compromised more quickly in pregnant women with even slight neuromuscular weakness. In addition, autonomic instability, which is common in GBS, can be amplified by the haemodynamic fluctuations inherent to labour and delivery. 2 , 3 Anaesthetic management for caesarean delivery in GBS remains a topic of debate. General anaesthesia poses specific concerns, including exaggerated responses to neuromuscular blocking drugs and the risk of postoperative respiratory failure. Although neuraxial procedures have traditionally been used with caution, several recent studies show that spinal or epidural anaesthesia can be successfully administered to carefully chosen parturients who do not have respiratory or bulbar compromise. 4 , 5 Given these overlapping risks, anaesthetic planning must be individualized and guided by available resources. We report a case of successful management of a GBS patient under spinal anaesthesia for emergency caesarean section, managed in a remote setup, with limited facilities. This highlights the practical decision-making required when balancing maternal safety, airway limitations, and neurological stability. CASE PRESENTATION A 23-year-old primigravida at 33 weeks and 2 days of gestation presented with complaints of lower abdominal pain, of a gradual onset, intermittent in nature. For threatened preterm labour, she was admitted for observation and treated conservatively with four intramuscular dexamethasone doses. The next day, she developed sudden-onset, progressive weakness of both lower limbs, followed by upper limb weakness, and was not able to stand without support. There was a history of a fall before the onset of weakness. She had no associated sensory loss, bowel or bladder involvement, cranial nerve symptoms, or respiratory distress. There were no known comorbidities. An orthopaedic consultation was obtained, and an MRI of the hip and femur showed no abnormalities. Subsequent neurological evaluation, including nerve conduction velocity studies, demonstrated a sensorimotor axonal neuropathy with mild demyelinating features and conduction block affecting the left ulnar and right peroneal nerves, findings consistent with Guillain–Barré syndrome. Intravenous immunoglobulin (IVIG) therapy was initiated at a total dose of 120 g over five days. The patient was transferred to the medical intensive care unit for IVIG administration. On the second day of therapy, she went into labour. In view of reduced lower limb power and inability to bear down, an emergency caesarean section was planned. On pre-anaesthetic evaluation, the Patient appeared oedematous with puffy facies and bilateral pedal edema extending up to the knee. Preoperative Vitals: PR-70bpm, BP-110/70 mmHg, RR-20cpm, Afebrile with no respiratory compromise, intact airway reflexes, and no bulbar involvement. Neurological examination showed muscle power of 4/5 in the upper limbs and 3/5 in the lower limbs. Airway evaluation showed a Modified Mallampati class III with no other abnormal findings. Following multidisciplinary consultation and after obtaining informed consent for high-risk procedures, a decision was made to proceed with regional anaesthesia. Subarachnoid block was administered in the left lateral position at the L3–L4 interspace using 10 mg of 0.5% hyperbaric bupivacaine, resulting in a sensory block up to the T4 dermatome. Intraoperative haemodynamics remained stable. Oxytocin was administered after delivery, and a healthy neonate was delivered. No vasopressor support was required. The patient was shifted to the intensive care unit for continuation of IVIG therapy. Sensory regression was gradual, and motor power returned to the preoperative baseline within six hours. Postoperative analgesia was achieved with paracetamol and tramadol, avoiding opioids that could depress respiration. No neurological deterioration was observed during the postoperative period. DISCUSSION Guillain–Barré syndrome in pregnancy presents unique anaesthetic challenges due to the risk of autonomic dysfunction, respiratory compromise, and altered responses to anaesthetic agents. There is limited evidence favouring a single anaesthetic technique, and management must be individualized based on neurological status, respiratory function, and available resources. General anaesthesia in GBS is associated with increased risk of aspiration due to autonomic instability and possible cranial nerve involvement. Furthermore, these patients exhibit increased sensitivity to non-depolarising neuromuscular blocking agents, leading to prolonged neuromuscular blockade and postoperative ventilatory dependence. Succinylcholine is contraindicated because of the risk of life-threatening hyperkalaemia in denervated muscles. 6 – 8 The use of regional anaesthesia in patients with Guillain–Barré syndrome has been debated, mainly because of concerns about potential worsening of neurological deficits and pronounced hypotension related to autonomic dysfunction. Nevertheless, recent literature suggests that neuraxial techniques may be safely employed in carefully selected patients who lack respiratory or bulbar involvement, provided that close haemodynamic monitoring is maintained 6 , 9 Several authors have reported successful use of neuraxial anaesthesia in parturients with GBS. Vassiliev et al. 10 described uneventful combined spinal-epidural anaesthesia for caesarean delivery in a patient with GBS. Gulhas et al. 11 reported successful epidural anaesthesia without neurological deterioration. Okahara et al. 12 recently described combined spinal-epidural anaesthesia in a primigravida with GBS receiving IVIG, with gradual neurological recovery postoperatively. In our case, we preferred spinal anaesthesia over general anaesthesia to avoid airway manipulation and the need for postoperative mechanical ventilation, particularly in a resource-limited setting. The patient had stable respiratory function, no autonomic instability, and preserved airway reflexes. Careful dosing, vigilant monitoring, and multidisciplinary coordination resulted in a favourable maternal and neurological outcome. CONCLUSION Guillain–Barré syndrome in pregnancy necessitates careful anaesthetic planning and an individualized approach to management. In selected patients without respiratory compromise or bulbar involvement, spinal anaesthesia may represent a safe and feasible option for caesarean delivery, even in resource-limited settings. Optimal maternal and fetal outcomes depend on thorough patient assessment, multidisciplinary collaboration, and vigilant perioperative monitoring. We conclude that the choice of anaesthesia should be based on the risk-benefit ratio of each technique. Abbreviations GBS Guillain–Barré Syndrome IVIG Intravenous Immunoglobulin Declarations Ethics approval and consent to participate: Ethical approval from the Institutional Ethics Committee of Kasturba Medical College, Mangalore: Approved; soft copy yet to be received. Written informed consent was obtained from the patient for participation and publication of clinical details. Consent for publication Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Availability of data and materials All data generated or analysed during this study are included in this published article. Competing interests The authors declare that they have no competing interests. Funding The authors received no financial support for this work. Authors’ contributions Shilpa A Naik: Writing – review and editing, methodology, validation, final approval. Prathvi B: Conceptualization, writing – original draft preparation. Ranjan R K: Supervision, critical revision of the manuscript, final approval. All authors read and approved the final manuscript. Acknowledgements The authors acknowledge Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, India for institutional support. References Yuki N, Hartung HP. Guillain–Barré syndrome. N Engl J Med. 2012;366:2294–304. Chan LY, Tsui MH, Leung TN. Guillain–Barré syndrome in pregnancy. Obstet Gynecol. 2004;103(3):485–90. Frawley G, Smith KR, de Silva A. Guillain–Barré syndrome in pregnancy: Implications for the anaesthetist. Anaesth Intensive Care. 2001;29:263–9. Agarwal A, Kishore K, Gupta D. Anaesthetic management of caesarean section in a patient with Guillain–Barré syndrome. J Anaesthesiol Clin Pharmacol. 2009;25:97–9. Sharma S, Hooda S, Malhotra N. Spinal anaesthesia for caesarean section in Guillain–Barré syndrome. Indian J Anaesth. 2017;61:1015–7. Richards JC, Cohen AT. Guillain–Barré syndrome. Br J Anaesth CEPD Rev. 2003;3(2):47–50. Sharma SR, Sharma N, Masaraf H, Singh SA. Guillain–Barré syndrome complicating pregnancy and correlation with maternal and fetal outcome. Ann Indian Acad Neurol. 2015;18:215–8. Kocabas S, Karaman S, Firat V, Bademkiran F. Anesthetic management of Guillain–Barré syndrome in pregnancy. J Clin Anesth. 2007;19:299–302. Miller RD, Eriksson LI, Fleisher LA, et al. Miller’s Anesthesia. 9th ed. Elsevier; 2020. Chapter 35. Vassiliev DV, Nystrom EU, Leicht CH. Combined spinal and epidural anesthesia for labor and cesarean delivery in a patient with Guillain–Barré syndrome. Reg Anesth Pain Med. 2001;26:174–6. Gulhas N, Kayhan GE, Karademir A, Sanli M, Durmus M. Anaesthetic management of Guillain–Barré syndrome in a pregnant woman. J Turgut Ozal Med Cent. 2017. Okahara S, Bowe R, Wong P, Johnson M. Caesarean section for a primipara with Guillain–Barré syndrome under combined spinal epidural anaesthesia. BMJ Case Rep. 2024;17:e260285. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 23 Apr, 2026 Reviewers agreed at journal 23 Apr, 2026 Reviews received at journal 21 Apr, 2026 Reviewers agreed at journal 21 Apr, 2026 Reviewers invited by journal 21 Apr, 2026 Editor assigned by journal 14 Mar, 2026 Editor invited by journal 10 Mar, 2026 Submission checks completed at journal 09 Mar, 2026 First submitted to journal 05 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8927026","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":629803907,"identity":"54f1ff2f-63e6-4ea7-a5f2-7a34f8ccf881","order_by":0,"name":"Shilpa A NAIK","email":"","orcid":"","institution":"Kasturba Medical College Mangalore","correspondingAuthor":false,"prefix":"","firstName":"Shilpa","middleName":"A","lastName":"NAIK","suffix":""},{"id":629803908,"identity":"411aa120-d266-461f-82c3-4f57a2c10cfe","order_by":1,"name":"Prathvi B","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYJACZgYGCQYD9gYg04CBgY8BxMUPGJvBWngOQLSwEakFqFgiAcIlqMVc+vDzx4VtFgzmkq8TPxcU3JFnY2A+eJsHjxbLvjTD5pltEgyWs3M3S88weGbYxsCWbI1Pi8EZBsNmnjNAv9zO3SDNY3CYsY2Bx0wavxb2jxAtN89u/g3UYt/GwP+NgBYeoC0VQC03eLeBbEkE2sKGV4tlD0/hbKAWHsue3G3WPAbPktuY2Ywt5+DRYs7DvuEzj0GdnDn72c23ef7cse1nb3544w0+h0FpmEsOgBMDXmCAxj9AQP0oGAWjYBSMRAAA6/1CuOftTmAAAAAASUVORK5CYII=","orcid":"","institution":"Kasturba Medical College Mangalore","correspondingAuthor":true,"prefix":"","firstName":"Prathvi","middleName":"","lastName":"B","suffix":""},{"id":629803910,"identity":"df3b4bfb-7022-4ac9-a87f-12418c4c2105","order_by":2,"name":"Ranjan R K","email":"","orcid":"","institution":"Kasturba Medical College Mangalore","correspondingAuthor":false,"prefix":"","firstName":"Ranjan","middleName":"R","lastName":"K","suffix":""}],"badges":[],"createdAt":"2026-02-20 14:53:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8927026/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8927026/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108181829,"identity":"2278cff6-f7d3-4d81-8dcc-b1023c49e4ca","added_by":"auto","created_at":"2026-04-30 08:58:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":116374,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8927026/v1/039e5b25-eb54-493e-9121-06c7c515e4b3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Successful Caesarean Section under Spinal Anaesthesia in a Pregnant Woman with Guillain–Barré Syndrome: A Case Report from a Resource-Limited Setting","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eAcute autoimmune neuropathy, Guillain-Barre syndrome (GBS), usually manifests as increasing weakness, decreased reflexes, and varied degrees of autonomic dysfunction. Even though it is uncommon, Guillain-Barr\u0026eacute; syndrome during pregnancy poses a challenging clinical problem since its neurological symptoms might resemble or overlap with the typical physiological changes that occur throughout gestation. Significant immunological changes are also associated with pregnancy, including a rebound in cell-mediated immunity during the postpartum phase and a shift towards humoral immunity in late gestation. The start or worsening of immune-mediated conditions like GBS in the third trimester or the early postpartum phase may be exacerbated by these alterations.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ePregnancy-related physiological changes in the mother, such as decreased respiratory reserve, increased oxygen consumption, increased susceptibility to positional hypotension, and higher circulatory demands, can enhance the unpredictability of GBS progression. Ventilation may be compromised more quickly in pregnant women with even slight neuromuscular weakness. In addition, autonomic instability, which is common in GBS, can be amplified by the haemodynamic fluctuations inherent to labour and delivery.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAnaesthetic management for caesarean delivery in GBS remains a topic of debate. General anaesthesia poses specific concerns, including exaggerated responses to neuromuscular blocking drugs and the risk of postoperative respiratory failure. Although neuraxial procedures have traditionally been used with caution, several recent studies show that spinal or epidural anaesthesia can be successfully administered to carefully chosen parturients who do not have respiratory or bulbar compromise.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eGiven these overlapping risks, anaesthetic planning must be individualized and guided by available resources. We report a case of successful management of a GBS patient under spinal anaesthesia for emergency caesarean section, managed in a remote setup, with limited facilities. This highlights the practical decision-making required when balancing maternal safety, airway limitations, and neurological stability.\u003c/p\u003e"},{"header":"CASE PRESENTATION","content":"\u003cp\u003eA 23-year-old primigravida at 33 weeks and 2 days of gestation presented with complaints of lower abdominal pain, of a gradual onset, intermittent in nature. For threatened preterm labour, she was admitted for observation and treated conservatively with four intramuscular dexamethasone doses.\u003c/p\u003e \u003cp\u003eThe next day, she developed sudden-onset, progressive weakness of both lower limbs, followed by upper limb weakness, and was not able to stand without support. There was a history of a fall before the onset of weakness. She had no associated sensory loss, bowel or bladder involvement, cranial nerve symptoms, or respiratory distress. There were no known comorbidities.\u003c/p\u003e \u003cp\u003eAn orthopaedic consultation was obtained, and an MRI of the hip and femur showed no abnormalities. Subsequent neurological evaluation, including nerve conduction velocity studies, demonstrated a sensorimotor axonal neuropathy with mild demyelinating features and conduction block affecting the left ulnar and right peroneal nerves, findings consistent with Guillain\u0026ndash;Barr\u0026eacute; syndrome. Intravenous immunoglobulin (IVIG) therapy was initiated at a total dose of 120 g over five days.\u003c/p\u003e \u003cp\u003eThe patient was transferred to the medical intensive care unit for IVIG administration. On the second day of therapy, she went into labour. In view of reduced lower limb power and inability to bear down, an emergency caesarean section was planned.\u003c/p\u003e \u003cp\u003eOn pre-anaesthetic evaluation, the Patient appeared oedematous with puffy facies and bilateral pedal edema extending up to the knee. Preoperative Vitals: PR-70bpm, BP-110/70 mmHg, RR-20cpm, Afebrile with no respiratory compromise, intact airway reflexes, and no bulbar involvement.\u003c/p\u003e \u003cp\u003eNeurological examination showed muscle power of 4/5 in the upper limbs and 3/5 in the lower limbs. Airway evaluation showed a Modified Mallampati class III with no other abnormal findings. Following multidisciplinary consultation and after obtaining informed consent for high-risk procedures, a decision was made to proceed with regional anaesthesia. Subarachnoid block was administered in the left lateral position at the L3\u0026ndash;L4 interspace using 10 mg of 0.5% hyperbaric bupivacaine, resulting in a sensory block up to the T4 dermatome. Intraoperative haemodynamics remained stable. Oxytocin was administered after delivery, and a healthy neonate was delivered. No vasopressor support was required.\u003c/p\u003e \u003cp\u003eThe patient was shifted to the intensive care unit for continuation of IVIG therapy. Sensory regression was gradual, and motor power returned to the preoperative baseline within six hours. Postoperative analgesia was achieved with paracetamol and tramadol, avoiding opioids that could depress respiration. No neurological deterioration was observed during the postoperative period.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eGuillain\u0026ndash;Barr\u0026eacute; syndrome in pregnancy presents unique anaesthetic challenges due to the risk of autonomic dysfunction, respiratory compromise, and altered responses to anaesthetic agents. There is limited evidence favouring a single anaesthetic technique, and management must be individualized based on neurological status, respiratory function, and available resources.\u003c/p\u003e \u003cp\u003eGeneral anaesthesia in GBS is associated with increased risk of aspiration due to autonomic instability and possible cranial nerve involvement. Furthermore, these patients exhibit increased sensitivity to non-depolarising neuromuscular blocking agents, leading to prolonged neuromuscular blockade and postoperative ventilatory dependence. Succinylcholine is contraindicated because of the risk of life-threatening hyperkalaemia in denervated muscles.\u003csup\u003e\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe use of regional anaesthesia in patients with Guillain\u0026ndash;Barr\u0026eacute; syndrome has been debated, mainly because of concerns about potential worsening of neurological deficits and pronounced hypotension related to autonomic dysfunction. Nevertheless, recent literature suggests that neuraxial techniques may be safely employed in carefully selected patients who lack respiratory or bulbar involvement, provided that close haemodynamic monitoring is maintained \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSeveral authors have reported successful use of neuraxial anaesthesia in parturients with GBS. Vassiliev et al.\u003csup\u003e10\u003c/sup\u003e described uneventful combined spinal-epidural anaesthesia for caesarean delivery in a patient with GBS. Gulhas et al.\u003csup\u003e11\u003c/sup\u003e reported successful epidural anaesthesia without neurological deterioration. Okahara et al.\u003csup\u003e12\u003c/sup\u003e recently described combined spinal-epidural anaesthesia in a primigravida with GBS receiving IVIG, with gradual neurological recovery postoperatively.\u003c/p\u003e \u003cp\u003eIn our case, we preferred spinal anaesthesia over general anaesthesia to avoid airway manipulation and the need for postoperative mechanical ventilation, particularly in a resource-limited setting. The patient had stable respiratory function, no autonomic instability, and preserved airway reflexes. Careful dosing, vigilant monitoring, and multidisciplinary coordination resulted in a favourable maternal and neurological outcome.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eGuillain\u0026ndash;Barr\u0026eacute; syndrome in pregnancy necessitates careful anaesthetic planning and an individualized approach to management. In selected patients without respiratory compromise or bulbar involvement, spinal anaesthesia may represent a safe and feasible option for caesarean delivery, even in resource-limited settings. Optimal maternal and fetal outcomes depend on thorough patient assessment, multidisciplinary collaboration, and vigilant perioperative monitoring. We conclude that the choice of anaesthesia should be based on the risk-benefit ratio of each technique.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGBS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGuillain\u0026ndash;Barr\u0026eacute; Syndrome\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIVIG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntravenous Immunoglobulin\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval from the Institutional Ethics Committee of Kasturba Medical College, Mangalore: Approved; soft copy yet to be received.\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for participation and publication of clinical details.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report and any accompanying images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShilpa A Naik: Writing \u0026ndash; review and editing, methodology, validation, final approval.\u003c/p\u003e\n\u003cp\u003ePrathvi B: Conceptualization, writing \u0026ndash; original draft preparation.\u003c/p\u003e\n\u003cp\u003eRanjan R K: Supervision, critical revision of the manuscript, final approval.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, India for institutional support.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eYuki N, Hartung HP. Guillain\u0026ndash;Barr\u0026eacute; syndrome. N Engl J Med. 2012;366:2294\u0026ndash;304.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChan LY, Tsui MH, Leung TN. Guillain\u0026ndash;Barr\u0026eacute; syndrome in pregnancy. Obstet Gynecol. 2004;103(3):485\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFrawley G, Smith KR, de Silva A. Guillain\u0026ndash;Barr\u0026eacute; syndrome in pregnancy: Implications for the anaesthetist. Anaesth Intensive Care. 2001;29:263\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgarwal A, Kishore K, Gupta D. Anaesthetic management of caesarean section in a patient with Guillain\u0026ndash;Barr\u0026eacute; syndrome. J Anaesthesiol Clin Pharmacol. 2009;25:97\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharma S, Hooda S, Malhotra N. Spinal anaesthesia for caesarean section in Guillain\u0026ndash;Barr\u0026eacute; syndrome. Indian J Anaesth. 2017;61:1015\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRichards JC, Cohen AT. Guillain\u0026ndash;Barr\u0026eacute; syndrome. Br J Anaesth CEPD Rev. 2003;3(2):47\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharma SR, Sharma N, Masaraf H, Singh SA. Guillain\u0026ndash;Barr\u0026eacute; syndrome complicating pregnancy and correlation with maternal and fetal outcome. Ann Indian Acad Neurol. 2015;18:215\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKocabas S, Karaman S, Firat V, Bademkiran F. Anesthetic management of Guillain\u0026ndash;Barr\u0026eacute; syndrome in pregnancy. J Clin Anesth. 2007;19:299\u0026ndash;302.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiller RD, Eriksson LI, Fleisher LA, et al. Miller\u0026rsquo;s Anesthesia. 9th ed. Elsevier; 2020. Chapter 35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVassiliev DV, Nystrom EU, Leicht CH. Combined spinal and epidural anesthesia for labor and cesarean delivery in a patient with Guillain\u0026ndash;Barr\u0026eacute; syndrome. Reg Anesth Pain Med. 2001;26:174\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGulhas N, Kayhan GE, Karademir A, Sanli M, Durmus M. Anaesthetic management of Guillain\u0026ndash;Barr\u0026eacute; syndrome in a pregnant woman. J Turgut Ozal Med Cent. 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOkahara S, Bowe R, Wong P, Johnson M. Caesarean section for a primipara with Guillain\u0026ndash;Barr\u0026eacute; syndrome under combined spinal epidural anaesthesia. BMJ Case Rep. 2024;17:e260285.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Caesarean section, Guillain–Barre syndrome (GBS), spinal anaesthesia, parturient, regional anaesthesia, resource-limited setup","lastPublishedDoi":"10.21203/rs.3.rs-8927026/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8927026/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eGuillain-Barre syndrome (GBS) is a rare but serious neurological condition due to autonomic instability, decreased respiratory function, and unpredictable medication responses, which can make pregnancy difficult and provide considerable anaesthetic issues. We report the case of a 23-year-old primigravida at 33 weeks of gestation who developed acute motor\u0026ndash;sensory neuropathy consistent with GBS and subsequently required emergency caesarean delivery. In a remote healthcare setting with limited airway and ventilatory resources, spinal anaesthesia was chosen after a multidisciplinary evaluation as the patient had stable respiratory function, with no bulbar involvement, and a potentially difficult airway. The intraoperative and postoperative periods were uneventful, and no neurological deterioration was observed. This case shows that, in certain GBS parturients, spinal anaesthesia can be a safe substitute for general anaesthesia, especially in settings with limited resources. Additionally, it emphasises the management of neuromuscular illness in high-risk obstetric patients by coordinated decision-making, meticulous monitoring, and individualized assessment.\u003c/p\u003e","manuscriptTitle":"Successful Caesarean Section under Spinal Anaesthesia in a Pregnant Woman with Guillain–Barré Syndrome: A Case Report from a Resource-Limited Setting","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-29 11:26:35","doi":"10.21203/rs.3.rs-8927026/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-23T12:18:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"310137041823157097500275066007356075979","date":"2026-04-23T08:33:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-21T11:39:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"255542101584980265805030430966011483593","date":"2026-04-21T08:24:39+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-21T08:06:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-14T07:44:55+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-10T04:45:31+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-09T13:13:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Anesthesiology","date":"2026-03-05T07:51:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"03d7373c-853e-47c9-bfa0-3733839b02f6","owner":[],"postedDate":"April 29th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-29T11:26:35+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-29 11:26:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8927026","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8927026","identity":"rs-8927026","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}