Tuesday June 17, 2008
accidental succinylcholine in pseudocholinesterase deficiency


Q: You have been called emergently to intubate patient with impending respiratory failure. You successfully intubate patient with rapid sequence using succinylcholine. While writing procedure note, you noticed patient has documented pseudocholinesterase deficiency. Now what is your other option beside waiting as respiratory muscle paralysis spontaneously resolves?



A: Use of succinylcholine should better be avoided in patients with pseudocholinesterase deficiency. But in situations, where reversal is intended, there are 3 options

1. Waiting - Recovery eventually occurs as a result of passive diffusion of succinylcholine away from the neuromuscular junction.
2. Transfusion of fresh frozen plasma. FFP can augment the patient's endogenous plasma pseudocholinesterase activity.
3. Administration of cholinesterase inhibitors, such as neostigmine, is controversial for reversing succinylcholine-related apnea in patients who are pseudocholinesterase deficient. The effects may be transient, possibly followed by intensified neuromuscular blockade.