Pseudocholinesterase Deficiency in Patient Undergoing Microlaringeal Surgery

Abstract

Introduction: Pseudocholinesterase deficiency is a genetic or acquired alteration in the metabolism of choline esters such as succinylcholine. Case description: A 70 years old female patient (body weight 48 kg, height 157 cm) was admitted to the hospital for microlaryngeal surgery. The preoperative interrogation revealed no significant personal or family history of adverse reaction to anesthetics. ASA classification is III. We performed a general anesthesia with intubation to the patient. Fentanyl 0.25 mg, propofol 150 mg and succinylcholine 70 mg were administered for anesthesia induction. After intubation 2% sevoflurane was used for anesthesia maintenance. The patient was unresponsive to external stimuli for 40 min since the end of the operation. Tree hours after operation, the patient had totally recovered from paralysis and tracheal tube was removed. Four days after operation the patient was discharged from hospital with no special discomfort. Discussion: Reduced plasma cholinesterase activity may occur as a result of inherited, acquired defects or iatrogenic causes. If the acquired defects are excluded low butyrylcholinesterase enzyme (BChE) activity is usually considered to be caused by mutations in butyrylcholinesterase gene (BCHE). There is no specific treatment for butyrylcholinesterase deficiency and the mainstream is to maintain ventilatory support until succinylcholine is metabolized out of the myoneural junction and neuromuscular function recovers. Transfusion of fresh frozen plasma is also viable. Conclusion: There is no specific treatment for plasma cholinesterase deficiency. The best and safest way is to let the patient recover spontaneously. Mechanical ventilation support is very important.