eMedicine Specialties > Neurosurgery > Miscellaneous

Pseudocholinesterase Deficiency: Treatment & Medication

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

Treatment

Medical Care

  • Pseudocholinesterase deficiency is a clinically silent condition in individuals who are not exposed to exogenous sources of choline esters.
  • Patients with prolonged paralysis following administration of succinylcholine can be treated in the following ways:
    • Prophylactic transfusion of fresh frozen plasma can augment the patient's endogenous plasma pseudocholinesterase activity. This practice is not recommended because of the risk of iatrogenic viral infectious complications. However, perioperative transfusion of fresh frozen plasma administered to correct a coagulopathy may mask an underlying pseudocholinesterase deficiency.
    • Mechanical ventilatory support is the mainstay of treatment until respiratory muscle paralysis spontaneously resolves. Recovery eventually occurs as a result of passive diffusion of succinylcholine away from the neuromuscular junction.
    • 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.

Consultations

  • Consultation with a geneticist may help to identify the specific atypical genotype alleles contributing to pseudocholinesterase deficiency.
  • Because the DNA sequence of the pseudocholinesterase gene and its amino acid structure is known, atypical alleles now can be identified by PCR amplification studies using DNA extracted from leukocytes in a blood sample.

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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