In respiratory paralysis due to acute neuropathy and especially in GBS, autonomic dysfunction is common.48-50,70 Tachycardia and loss of sinus arrhythmia are usual. Rapid fluctuations of pulse and blood pressure and sweating may occur and are sometimes the harbingers of asystole, especially during tracheal toilet. This can usually be prevented by hyperoxygenation before tracheal suction, but if it persists it may be necessary to use atropine and even an endocardial pacemaker. Serious arrhythmias usually only occur in patients who need ventilation, but we have had a patient with early GBS who developed asystole before needing ventilation. We monitor the ECG from the time of admission in all patients with GBS who have any sign of respiratory or bulbar involvement and continue until improvement has begun and the endotracheal tube has been removed. Although the bladder is spared in the early stages of GBS, it may be affected in severe cases and bladder catheterisation is often needed as part of the intensive care of the ventilated patient. Postural hypotension is common when the patient is being mobilised so that the blood pressure should be monitored. This is best done with the aid of a tilt table.
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