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.