Abstract
IntroductionPseudocholinesterase (butyrylcholinesterase) is a drug metabolizing enzyme responsible for hydrolysis of the muscle relaxant drugs succinylcholine and mivacurium. Deficiency from any cause can lead to prolonged apnoea and paralysis following administration of succinylcholine and mivacurium.Case presentationWithin the last two years we have had four patients who have had prolonged apnea following the administration of mivacurium. It was understood that one was congenital and the other three due to various reasons had enzyme-deficiencies. In all four of the patients, the prolonged blocks deteriorated.ConclusionProlonged blocks may be encountered due to mivacurium use. The diagnosis of pseudocholinesterase enzyme deficiency can be given after a careful clinic supervision and peripheral nerve stimulator monitoring. A decrease in the activity of pseudocholinesterase enzyme and improvement in neuromuscular function will help verifying our diagnosis. Instead of pharmacological applications that may further complicate the situation, what should be done in such patients is to wait until the block-effect goes down by the help of sedation and mechanical ventilation.
Highlights
Pseudocholinesterase is a drug metabolizing enzyme responsible for hydrolysis of the muscle relaxant drugs succinylcholine and mivacurium
The diagnosis of pseudocholinesterase enzyme deficiency can be given after a careful clinic supervision and peripheral nerve stimulator monitoring
Mivacurium, which is a nondepolarizing neuromuscular blocking drug administered in doses of 0.1 to 0.2 mg/kg, produces rapid onset of neuromuscular blockade lasting 15 to 30 minutes [5]
Summary
We may find out that prolonged blocks can be encountered as a result of PChE enzyme defect when mivacurium is used This situation can either be from congenital as in one of our patients (Patient 4) or due to various resons (pregnancy, malnutrition and sertraline use) as in the other three patients. In the cases of prolonged block, no reversal was attempted, the cases were kept sedated and their lungs mechanically ventilated until the block had recovered spontaneously, and extubated without problems. This patient had a much less traumatic experience than the others, in whom pharmacological reversal was attempted. A copy of the written consent is available for review by the Editor-in-Chief of this journal
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