eMedicine Specialties > Neurosurgery > Miscellaneous

Pseudocholinesterase Deficiency: Follow-up

Author: Daniel R Alexander, MD, Consulting Staff, Departments of Internal Medicine and Pathology, Franklin Square Hospital Center
Contributor Information and Disclosures

Updated: May 1, 2009

Follow-up

Complications

  • The main complication resulting from pseudocholinesterase deficiency is the possibility of respiratory failure secondary to succinylcholine or mivacurium-induced neuromuscular paralysis.
  • Individuals with pseudocholinesterase deficiency also may be at increased risk of toxic reactions, including sudden cardiac death, associated with recreational use of cocaine.

Prognosis

  • Prognosis for recovery following administration of succinylcholine is excellent when medical support includes close monitoring and respiratory support measures.
  • In nonmedical settings in which subjects with pseudocholinesterase deficiency are exposed to cocaine, sudden cardiac death can occur.

Patient Education

  • Patients with known pseudocholinesterase deficiency may wear a medic-alert bracelet that will notify healthcare workers of increased risk from administration of succinylcholine.
  • These patients also may notify others in their family who may be at risk for carrying one or more abnormal pseudocholinesterase gene alleles.

Miscellaneous

Medicolegal Pitfalls

  • Failure to take an adequate history of previous adverse reactions to succinylcholine, mivacurium, or cocaine in either the patient's own medical history or in the family history
  • Failure to monitor skeletal muscle paralysis by electrical tetanic stimulation
  • Failure to provide adequate respiratory function monitoring and support after the administration of succinylcholine or mivacurium
 


More on Pseudocholinesterase Deficiency

Overview: Pseudocholinesterase Deficiency
Differential Diagnoses & Workup: Pseudocholinesterase Deficiency
Treatment & Medication: Pseudocholinesterase Deficiency
Follow-up: Pseudocholinesterase Deficiency
Multimedia: Pseudocholinesterase Deficiency
References
Further Reading
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References

  1. Leadingham CL. A case of pseudocholinesterase deficiency in the PACU. J Perianesth Nurs. Aug 2007;22(4):265-71; quiz 272-4. [Medline].

  2. Williams J, Rosenquist P, Arias L, McCall WV. Pseudocholinesterase deficiency and electroconvulsive therapy. J ECT. Sep 2007;23(3):198-200. [Medline].

  3. Duysen EG, Li B, Carlson M, Li YF, Wieseler S, Hinrichs SH, et al. Increased hepatotoxicity and cardiac fibrosis in cocaine-treated butyrylcholinesterase knockout mice. Basic Clin Pharmacol Toxicol. Dec 2008;103(6):514-21. [Medline].

  4. Li B, Duysen EG, Carlson M, Lockridge O. The butyrylcholinesterase knockout mouse as a model for human butyrylcholinesterase deficiency. J Pharmacol Exp Ther. Mar 2008;324(3):1146-54. [Medline].

  5. Cerf C, Mesguish M, Gabriel I, et al. Screening patients with prolonged neuromuscular blockade after succinylcholine and mivacurium. Anesth Analg. Feb 2002;94(2):461-6, table of contents. [Medline].

  6. Dietz AA, Rubinstein HM, Lubrano T. Colorimetric determination of serum cholinesterase and its genetic variants by the propionylthiocholine-dithiobis(nitrobenzoic acid)procedure. Clin Chem. Nov 1973;19(11):1309-13. [Medline].

  7. Jatlow P, Barash PG, Van Dyke C. Cocaine and succinylcholine sensitivity: a new caution. Anesth Analg. May-Jun 1979;58(3):- Van Dyke C. [Medline].

  8. Jensen FS, Viby-Mogensen J. Plasma cholinesterase and abnormal reaction to succinylcholine: twenty years' experience with the Danish Cholinesterase Research Unit. Acta Anaesthesiol Scand. Feb 1995;39(2):150-6. [Medline].

  9. Kalow W, Genest K. A method for the detection of atypical forms of human serum cholinesterase; determination of dibucaine numbers. Can J Biochem Physiol. Jun 1957;35(6):339-46. [Medline].

  10. Lange D, du Pasquier Y. [Study of cellular immunity in the course of nephro-epithelioma. Preliminary study concerning 12 cases (author's transl)]. J Urol Nephrol (Paris). Jul-Aug 1975;81(7-8):543-8. [Medline].

  11. Lehmann H, Liddell J, M - 196907. Human cholinesterase (pseudocholinesterase): genetic variants and their recognition. Br J Anaesth. Mar 1969;41(3):235-44. [Medline].

  12. Lovely MJ, Patteson SK, Beuerlein FJ, Chesney JT. Perioperative blood transfusion may conceal atypical pseudocholinesterase. Anesth Analg. Mar 1990;70(3):326-7. [Medline].

  13. Maiorana A, Roach RB Jr. Heterozygous pseudocholinesterase deficiency: a case report and review of the literature. J Oral Maxillofac Surg. Jul 2003;61(7):845-7. [Medline].

  14. Pantuck EJ. Plasma cholinesterase: gene and variations. Anesth Analg. Aug 1993;77(2):380-6. [Medline].

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Keywords

pseudocholinesterase deficiency, plasma cholinesterase deficiency, butyrylcholinesterase deficiency, cholinesterase II deficiency

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Contributor Information and Disclosures

Author

Daniel R Alexander, MD, Consulting Staff, Departments of Internal Medicine and Pathology, Franklin Square Hospital Center
Daniel R Alexander, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Clinical Pathology, College of American Pathologists, and MedChi
Disclosure: Nothing to disclose.

Medical Editor

Scott C Dulebohn, MD, Neurological Surgeon, Appalachian Neurosurgical
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Allen R Wyler, MD, Former Medical Director, Northstar Neuroscience, Inc
Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

Allen R Wyler, MD, Former Medical Director, Northstar Neuroscience, Inc
Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

 
 
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