Manajemen Anestesi dan Perawatan Intensif pada Pasien Guillain-Barré Syndrome dengan Gagal Napas akibat Kelemahan Otot Respirasi Progresif
Kata Kunci:
Guillain-Barré Syndrome, gagal napas, ventilasi mekanik, anestesi, EGRISAbstrak
Pendahuluan: Guillain-Barré syndrome (GBS) dapat berkembang cepat menjadi gagal napas akibat kelemahan otot respirasi dan disfungsi bulbar, sehingga identifikasi dini pasien berisiko tinggi penting untuk perencanaan perawatan intensif dan pengamanan jalan napas.
Kasus: Seorang laki-laki 42 tahun dengan kelemahan progresif keempat ekstremitas, baal, disartria, dan sesak memburuk hingga mengalami distress napas, gangguan oksigenasi, penurunan kesadaran, serta keterlibatan bulbar di ruang ICU. Pasien kemudian dilakukan intubasi terencana (fentanyl, propofol, dan rocuronium; suksinilkolin dihindari karena risiko hiperkalemia), dilanjutkan ventilasi mekanik, sedasi, terapi suportif, dan plasmapheresis serial hingga berhasil disapih dan diekstubasi.
Pembahasan: Kasus ini menegaskan pentingnya penilaian risiko respirasi sejak awal, termasuk Erasmus GBS Respiratory Insufficiency Score (EGRIS), sebagai pelengkap (bukan pengganti) penilaian klinis serial, fungsi bulbar, dan pemeriksaan fungsi respirasi bedside, serta pentingnya pemilihan obat anestesi yang tepat, ventilasi individual, imunomodulasi, dan weaning berbasis pemulihan fungsi.
Simpulan: Pada GBS dengan progresivitas cepat dan keterlibatan bulbar, EGRIS dapat memperkuat keputusan untuk melakukan pemantauan di ICU dan menyiapkan pengamanan jalan napas secara terencana. Pendekatan terpadu berpotensi mencegah keterlambatan intubasi dan komplikasi respirasi
Unduhan
Referensi
van den Berg B, Walgaard C, Drenthen J, Fokke C, Jacobs BC, van Doorn PA. Guillain-Barré syndrome: pathogenesis, diagnosis, treatment and prognosis. Nat Rev Neurol. 2014;10(8):469–82. doi: 10.1038/nrneurol.2014.121
Walgaard C, Lingsma HF, Ruts L, van Doorn PA, Steyerberg EW, Jacobs BC. et al. Early recognition of poor prognosis in Guillain-Barré syndrome. Neurology. 2011;76(11):968–75. doi: 10.1212/WNL.0b013e3182104407
Lawn ND, Fletcher DD, Henderson RD, Wolter TD, Wijdicks EFM. Anticipating mechanical ventilation in Guillain-Barré syndrome. Arch Neurol. 2001;58(6):893–98.
Deilami M, Sahraei R, Sanie Jahromi MS, Vatankhah M, Malekshoar M, Adibi P, et al. Mechanical ventilation and anesthesia strategies in patients with acute respiratory failure due to Guillain-Barré syndrome: a narrative review. Int J Med Invest. 2023;12(3):1–10.
Sekiguchi Y, Misawa S, Morooka M, Suichi T, Shiko Y, Takahashi K, et al. Utility of the modified Erasmus GBS Respiratory Insufficiency Score in axonal and demyelinating Guillain-Barré syndrome. J Peripher Nerv Syst. 2026;31(1):e70096. doi:10.1111/jns.70096.
Luijten,LWG, Doets AY, Arends S, Dimachkie MM, Gorson KC, Islam B, et al. Modified Erasmus GBS Respiratory Insufficiency Score: a simplified clinical tool to predict the risk of mechanical ventilation in Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry. 2023;94(4):300–08
Haridy NA, Shehab MM, Khedr EM. Long-term outcomes of plasma exchange versus intravenous immunoglobulin for the treatment of Guillain-Barré syndrome: a double-blind, randomized clinical trial. Restor Neurol Neurosci. 2024;41(5-6):293–303. doi: https://doi.org/10.3233/RNN-231369
Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group. Randomised trial of plasma exchange, intravenous immunoglobulin, and combined treatments in Guillain-Barré syndrome. Lancet. 1997;349(9047):225–30.
Sani F, Aditya R. Management of patients with Guillain-Barré syndrome in the intensive care unit. J Soc Med. 2025;4(5):165–9. doi: 10.71197/jsocmed.v4i5.212
Rangwalla K, Agrawal A. Guillain-Barré syndrome [Internet]. OpenAnesthesia. Updated 2025 Feb 19 [cited 2026 Jul 6]. Available from: https://www.openanesthesia.org/keywords/guillain-barre-syndrome/
Daniel S, Green R. Guillain-Barré syndrome [Internet]. London: World Federation of Societies of Anaesthesiologists; 2011 [cited 2026 Jun 4]. Tersedia dari: https://resources.wfsahq.org/wp-content/uploads/238_english-1.pdf
Saha M, Saha A. Tackling respiratory failure in Guillain-Barré syndrome. Expert Rev Respir Med. 2024 ;18(8):575–83 [cited 2026 Jun 4]. Available from: https://pubmed.ncbi.nlm.nih.gov/4058758
NYSORA. Guillain-Barré syndrome [Internet]. 2026 [cited 2026 Jun 4]. Tersedia dari: https://www.nysora.com/anesthesia/guillain-barre-syndrome/
