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I am grateful for Dr Pace's interest and comments. Regrettably, we did not obtain blood gas measurements while the child was being suctioned and it was not possible directly to respond to his suggestions. However, we did notice that suctioning during other times of the illness was only infrequently associated with arrhythmias, although these became predictable when other signs of autonomic dysfunction occurred. Furthermore, suctioning continued during convalescence after the pacemaker was removed and no more arrhythmias occurred. Therefore, it may be that a combination of hypoxia and neurological damage is necessary for these serious cardiac complications to occur. Further clinical investigation undoubtedly will provide the answers.
Emmons PR. Cardiac Monitoring and Demand Pacemaker in Guillain-Barré Syndrome-Reply. Arch Neurol. 1976;33(5):374. doi:10.1001/archneur.1976.00500050060018
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