Abstract
Pseudocholinesterase (butyrylcholinesterase) deficiency is an inherited or acquired condition in which the serum pseudocholinesterase levels are absent or lower than normal. The enzyme is produced by the liver; decreased levels of the enzyme in an individual cause increased sensitivity to anesthetic agents, like succinylcholine and mivacurium. Pseudocholinesterase deficiency is caused by butyrylcholinesterase (BCHE) gene mutation, a gene that provides instructions for making the pseudocholinesterase enzyme. Succinylcholine is a depolarizing muscle relaxant that provides a quicker onset and a brief duration of muscle relaxation during general anesthesia. In this article, we would like to discuss a case report of prolonged intubation and ventilation in a patient with pseudocholinesterase deficiency and the necessity of succinylcholine during intubation in comparison to possible alternatives (rocuronium).
Highlights
Pseudocholinesterase is an enzyme produced in the liver and is responsible for the metabolism of several common anesthetic drugs, including mivacurium and succinylcholine
Pseudocholinesterase deficiency is caused by butyrylcholinesterase (BCHE) gene mutation, a gene that provides instructions for making the pseudocholinesterase enzyme
Many individuals may be suspected of pseudocholinesterase deficiency or with a family history of prolonged action to succinylcholine, testing can be done prior to surgery to determine if an individual has the pseudocholinesterase deficiency condition [7]
Summary
Pseudocholinesterase (butyrylcholinesterase) is an enzyme produced in the liver and is responsible for the metabolism of several common anesthetic drugs, including mivacurium and succinylcholine. In an individual with a pseudocholinesterase deficiency, there is a reduced ability to efficiently metabolize these anesthetic medications which results in the prolonged effect of neuromuscular paralysis [3,4]. This prolonged neuromuscular blockade requires intensive care unit (ICU) or post-anesthesia care unit (PACU) stay for mechanical ventilation until normal breathing resumes. The patient had no prior medical history (American Society of Anesthesiologists (ASA) physical status 1). Her past surgical history included breast reduction surgery one year prior with no anesthetic complications. The patient was observed for 24 hours, informed about the pseudocholinesterase deficiency, and discharged home the following day with no further complications
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