Pseudocholinesterase Deficiency and Patient Perspectives

Davis Jevaughn,Shanmugam Geetha,Vincent Anita

doi:10.23937/2377-4630/1410124

Davis Jevaughn, Shanmugam Geetha + Show 1 more

Open Access

https://doi.org/10.23937/2377-4630/1410124

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Abstract

Pseudocholinesterase deficiency, commonly referred to as Butyrylcholinesterase deficiency, is a rare, inherited, or acquired condition that results in decreased or absent enzymatic activity. Pseudocholinesterase is a plasma enzyme that is responsible for the breakdown of succinylcholine and mivacurium, which are commonly used paralytic agents. People with this condition are usually unaware they have the disease, and the disease may not manifest until extubation at the end of surgery.

Highlights

Emergence from anesthesia can be delayed by many factors; one of the more rare causes is pseudocholinesterase deficiency
We present two cases of prolonged paralysis after succinylcholine administration subsequently confirmed by laboratory testing to be pseudocholinesterase deficiency
Pseudocholinesterase deficiency is of importance to anesthesiologists because patients with this deficiency will exhibit prolonged paralysis with the aforementioned agents leading to continued mechanical ventilation hours after surgical completion

Summary

Introduction

Emergence from anesthesia can be delayed by many factors; one of the more rare causes is pseudocholinesterase deficiency. These patients will usually have abnormally prolonged paralysis time and require mechanical ventilation well into the post anesthesia care unit because of failure to meet qualitative and quantitative extubation criteria. Treatment is mainly supportive with continued mechanical ventilation until return of muscle function because paralysis can last from minutes to hours and re-sedation to limit patient discomfort. We present two cases of prolonged paralysis after succinylcholine administration subsequently confirmed by laboratory testing to be pseudocholinesterase deficiency.

Results

Conclusion