Expert: Ronald Levy, M.D. - 3/4/2008

Question
If someone has been sedated and paralyzed for approx. 3wks to 1 month, how long after the paralytic drug has been stopped will it take them to be able to move there extremeties, even so much as one finger?  I ask because my sister is in ICU at a Houston hospital and the paralytic was discon't. 6 days ago and the most she can do is stick out her tongue, blink eyes, nod head.  She started out w/ Pneumonia, developed ARDS, along with a multitude of other problems.  Still on vent, w/ trach at 89% support.  Is it crazy for me to think she has developed Guillian Barre' Syndrome and wouldn't a Spinal Tap show this?

Answer
It can take a while for paralytics to wear off (I can't give you an exact time as it depends on a number of factors). As for Gullian Barre`, it can develop at any time (for any reason). I speak from experience because I developed a mild form of it after getting over the flu. That is not to say that she has that, but it should certainly be worked up. A spinal tap is not diagnostic, just suggestive. Your sister has enough things to weaken her condition that there could be a vareity of reasons why she is still paralyzed. The important thing is that while she is paralyzed that she be sedated (because there is nothing worse that being paralyzed and awake). Of course, this presents a paradox because if they sedate her, then she won't be awake enough to demonstrate return of function.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston