[Frequency distribution of dibucaine numbers in 24,830 patients].
OBJECTIVE
Atypical cholinesterase prolongs the duration of neuromuscular blocking drugs such as succinylcholine and mivacurium. Measuring the dibucaine number identifies patients who are at risk. This study shows the frequency distribution of dibucaine numbers routinely measured and discusses avoidable clinical problems and economic implications.


METHODS
Dibucaine numbers were measured on a Hitachi 917-analyzer and all dibucaine numbers recorded over a period of 4 years were taken into consideration. Repeat observations were excluded.


RESULTS
A total of 24,830 dibucaine numbers were analysed and numbers below 30 were found in 0.07% ( n=18) giving an incidence of 1:1,400. Dibucaine numbers from 30 to 70 were found in 1.23% ( n=306). On the basis of identification of the Dibucaine numbers we could avoid the administration of succinylcholine or mivacurium resulting in a cost reduction of 12,280 Euro offset against the total laboratory costs amounting to 10,470 Euro.


CONCLUSIONS
An incidence of 1:1,400 of dibucaine numbers below 30 is higher than documented in the literature. Therefore, routine measurement of dibucaine number is a cost-effective method of identifying patients at increased risk of prolonged neuromuscular blockade due to atypical cholinesterase.
Pestel
G
G
Institut für Anaesthesiologie und Intensivmedizin, Leopoldina-Krankenhaus, Schweinfurt. gunther.pestel@imex.pur.de
Sprenger
H
H
Rothhammer
A
A
D000758:Anesthesia / Q000009:adverse effects* / Q000191:economics; D000779:Anesthetics, Local; D002800:Cholinesterase Inhibitors / Q000009:adverse effects*; D002802:Cholinesterases / Q000235:genetics*; D019411:Clinical Laboratory Techniques; D003992:Dibucaine; D006801:Humans; D007546:Isoquinolines / Q000009:adverse effects* / Q000191:economics; D000077590:Mivacurium; D009467:Neuromuscular Depolarizing Agents / Q000009:adverse effects* / Q000191:economics; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects* / Q000191:economics; D013390:Succinylcholine / Q000009:adverse effects* / Q000191:economics
D000779:Anesthetics, Local; D002800:Cholinesterase Inhibitors; D007546:Isoquinolines; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D000077590:Mivacurium; D002802:Cholinesterases; D013390:Succinylcholine; D003992:Dibucaine