Hypo- and hypersensitivity to vecuronium in a patient with Guillain-Barré syndrome.

uillain-Barre syndrome is a polyradiculoneuropathy characterized by multifocal distribuG tion of demyelination and varying amounts of secondary axonal degeneration (1). The extent to which proximal and distal muscles may be denervated and reinnervated is unpredictable in this disease. Usually, electromyographic (EMG) evidence of denervation appears between the second and fourth weeks of the disease and evidence of reinnervation appears between the fourth and fifth weeks (frequently in the plateau phase of neurologic impairment), reaching a maximum many months thereafter (i.e., usually when the patient has resumed normal activity) (1). Patients recovering from Guillain-Barre syndrome may be at risk for hyperkalemic accidents caused by succinylcholine (2). Indirect evidence suggests that they might also be at risk for prolonged paralysis after receiving nondepolarizing muscle relaxants (NDMR) (3-5). The following case report suggests that the sensitivity to NDMR might be decreased or increased in these patients according to the stage of their disease.