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May 1976

Cardiac Monitoring and Demand Pacemaker in Guillain-Barré Syndrome

Author Affiliations

Anesthesia and Operative Service Brooke Army Medical Center Fort Sam Houston, TX 78234

Arch Neurol. 1976;33(5):374. doi:10.1001/archneur.1976.00500050060017

To the Editor.—  Emmons et al (Arch Neurol 32:59, 1975) reported the use of a temporary transvenous demand pacemaker to prevent cardiac arrest from severe arrhythmias that developed during tracheal suctioning in an 11-year-old child with Guillain-Barré syndrome receiving continuous mechanical ventilation. Each episode of suctioning was associated with sinus bradycardia (day 6) or idioventricular bradycardia (days 7-12), as well as profuse diaphoresis, restlessness, and an ashen-gray color. Following suctioning, the cardiac rhythm reverted to a sinus tachycardia with systemic hypertension. The authors attributed these arrhythmias to the autonomic dysfunction that may occur with the Guillain-Barré syndrome.Previous work in the management of patients receiving continuous mechanical ventilation suggests a different cause and treatment for the observed arrhythmias. With the widespread use of mechanical ventilation to manage respiratory failure, reports of cardiac arrest during and immediately following endotracheal suctioning are not infrequent.1,2 Cardiac arrest during prolonged aspiration of the

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