SummaryTwo case histories of pregnant women with Guillain Barre  syndrome (acute demyelinating polyradiculoneuritis) are reported. The ®rst required anaesthesia during the second trimester for a minor surgical procedure. The second woman was admitted to the Intensive Care Unit in the ®rst trimester and was ventilated for 18 weeks. Both babies were carried to term and delivered by Caesarean section. A review of the management of Guillain Barre  syndrome in pregnancy discusses anaesthetic management, intensive care and the use of plasmapheresis and g-globulins. The care of pregnant women recovered from Guillain Barre  syndrome is also discussed.

SummaryAs anaesthetists have become more aware of malignant hyperthermia the mortality rate has fallen, but concommitantly the number of dubious and aborted cases has increased. Key wordsHyperthermia; malignant.The fulminant, classical occurrence of a malignant hyperthermia (MH) reaction is now encountered less frequently because of increased awareness of the condition by anaesthetists, and better use of monitoring facilities. There is also an increase in the number of aborted cases, in which anaesthesia is stopped and treatment instituted as soon as MH is thought to be likely. This means there are fewer obvious signs of MH and, since no clinical sign is unique to MH, the decision as to whether to proceed to further investigation is made more difficult. Not only has the number of aborted cases of MH increased but also the overall number of cases referred to us. In this paper, by relating the type of clinical presentation of M H with the results of in vitro muscle biopsy screening, we hope to identify which features of the clinical presentation carry a higher probability for an accurate clinical diagnosis of MH.There is no current method of classifying the clinical reactions of MH. Britt' grouped patients as having rigid or nonrigid reactions, but this has not been adhered to by others. The attempt to categorise clinical reactions naturally followed the recognition of masseter spasm as a clinical problem. The classification used in this paper was developed from an original suggestion by 0rding and Ranklev (personal communication). Methods Classijication of the probandsAll probands referred to the unit after a suspected MH reaction during anaesthesia and who were investigated by muscle biopsy are included. If the proband had died or was too young to be investigated, they were 'diagnosed' indirectly using the results of relatives, usually parents. There was no complete record of all the signs associated with MH in the majority of cases, in particular the recognition and measurement of myoglobinuria. However, the clinical history often gave a good 'impression' of the problem and the patient was categorised accordingly. It was therefore impossible to keep to strict objective criteria when classifying each patient. Each proband was allocated to one of eight mutually exclusive categories, according to their clinical history given by the referring physician, as follows.Fulminanticlassical. Marked evidence of both metabolic stimulation and abnormal muscle activity; the signs include metabolic acidosis, hyperthermia ( > 38.5"C), arrhythmias, hyperkalaemia, muscle rigidity, myoglobinuria and greatly raised creatine kinase (CK) ( > 1500 IU/litre). These probands all received active treatment and the situation appeared life-threatening (category a).Moderate. Inconclusive signs of MH that involved both metabolic and muscle anomalies with M H being a probable diagnosis. These patients either did not receive active treatment or only a single dose of dantrolene. No treatment was required after withdrawal of trigger agents and t...

The occurrence of masseteric muscle spasm (MMS) in children is thought to be frequent and to be associated usually with malignant hyperpyrexia (MH). We have found a lower incidence of MMS in children and 50% had no muscle abnormality. Clinical features that support a diagnosis of MH include high serum creatine kinase (CK) concentration and the presence of myoglobinuria. There is evidence to suggest that suxamethonium does increase jaw tone in adults and children, and an exaggerated response may be taken clinically to be MMS. However, MMS should still be regarded as an early warning sign of MH.

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