title: Cumulative reduction in serum cholinesterase following repeated therapeutic plasma exchange.
abstract: OBJECTIVE
  To investigate the magnitude of serum cholinesterase reduction following repeated therapeutic plasma exchange in patients with neuromuscular disease.
  
  
  METHODS
  Serum cholinesterase activity was measured immediately before and after each plasma exchange in open-label fashion and then analyzed using an analysis of variance model.
  
  
  METHODS
  Inpatient neurology and allergy and immunology clinics at a university-affiliated hospital.
  
  
  METHODS
  50 consecutive patients with neuromuscular disease.
  
  
  METHODS
  All patients underwent repeated therapeutic plasma exchange, with each subject receiving up to a maximum of six plasma exchanges.
  
  
  RESULTS
  Serum cholinesterase activity was determined spectrophotometrically. Analysis of variance revealed a significant reduction in serum cholinesterase following each therapeutic plasma exchange (p < 0.0001), a significant and consistent reduction across the six treatments (p < 0.0001), and a significant interaction between (before versus after exchange) and treatment number (p < 0.0001). Mean serum cholinesterase before repeated therapeutic plasma exchange was 4817 U/L, but it decreased to a mean of 929 U/L following six plasma exchanges.
  
  
  CONCLUSIONS
  There is a significant reduction in serum cholinesterase following repeated therapeutic plasma exchange. It is suggested that drugs metabolized by serum cholinesterase (e.g., succinylcholine, mivacurium) be used with caution in the period immediately following repeated therapeutic plasma exchange.
authors.affiliation: Department of Anesthesia, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: C D
authors.initials: CD
authors.lastname: Collard
authors.forename: B W
authors.initials: BW
authors.lastname: Baker
authors.forename: D
authors.initials: D
authors.lastname: Johnson
authors.forename: R
authors.initials: R
authors.lastname: Bressler
authors.forename: Y
authors.initials: Y
authors.lastname: Harati
mesh_terms: D000758:Anesthesia; D002802:Cholinesterases / Q000097:blood*; D006801:Humans; D007546:Isoquinolines; D000077590:Mivacurium; D009467:Neuromuscular Depolarizing Agents; D009468:Neuromuscular Diseases / Q000628:therapy*; D003473:Neuromuscular Nondepolarizing Agents; D010951:Plasma Exchange / Q000009:adverse effects*; D012307:Risk Factors; D013390:Succinylcholine
chemical_list: D007546:Isoquinolines; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D000077590:Mivacurium; D002802:Cholinesterases; D013390:Succinylcholine