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Canadian Journal of Anesthesia, Vol 33, 657-661, Copyright © 1986 by Canadian Anesthesiologists' Society

Multiple Neuromuscular Blocking Agents and Reversal in A Patient with Absent Plasma Cholinesterase

MICHAEL H. M. DYKES MB BCHIR MED1, SZE-CHUH CHENG PHD1, HARRY COHEN MD1, and RAFAEL F. VALLE MD1

1 Departments of Anesthesia and Obstetrics and Gynecology, Northwestern University Medical School, and Northwestern Memorial Hospital, Chicago, Illinois

Address correspondence to: Dr. Dykes, Northwestern Memorial Hospital, Room 360, 303 East Superior Street, Chicago, Illinois 60611.

The detailed clinical response of a patient with absent plasma cholinesterase (genotype E1s E1s) who received tubocurarine (3 mg), succinylcholine (120 mg), pancuronium (2 mg), and reversal with neostigmine (3 mg) is reported. The patient's responses were compared to the responses of a group of patients with genotype E1a E1a evaluated prospectively, and with eight other genotype E1s E1spatients reported in the literature. The present patient demonstrated evidence of a phase II block before and after attempted reversal, suggesting that free succinylcholine was present in her plasma and a mixed block was present at that time. Conservative supportive therapy was continued and a complete recovery resulted five hours and 30 minutes after the succinylcholine administration.

Key Words: NEUROMUSCULAR RELAXANTS: tubocurarine, succinylcholine • ENZYMES: plasma cholinesterase • GENETIC FACTORS: plasma cholinesterase, silent gene






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Copyright © 1986 by the Canadian Anesthesiologists' Society.