title: Plasma pseudo cholinesterase deficiency leading to seven hour apnoea in a child undergoing adeno-tonsillectomy.
abstract: OBJECTIVE
  We report a rare, silent, potentially fatal operative complication of seven hour apnoea in a patient undergoing adenotonsillectomy secondary to deficiency of plasma cholinesterase. Awareness of this hereditary disorder is important to otolaryngologist as; it is difficult to diagnose, can be unexpectedly alarming for parents and the surgeon.
  
  
  METHODS
  Case report and review of world literature.
  
  
  RESULTS
  A four-year male with obstructive sleep apnoea underwent a routine elective adenotonsillectomy; there was no spontaneous recovery of respiration following surgery. He was transferred to the intensive care unit and 7 h later was successfully weaned from the ventilator and extubated. A plasma cholinesterase level of 456 1U/L was discovered much later.
  
  
  CONCLUSIONS
  To our knowledge this is the first case report of pseudo cholinesterase deficiency reported in otolaryngology literature and first in Oman. The patient should receive information about the condition, the associated risks, inheritance and need for testing other family members.
authors: ENT Division, Department of Surgery, College of Medicine, Sultan Qaboos University Hospital, Oman. deepaent@gmail.com
authors: Deepa
authors: D
authors: Bhargava
authors: Jasvinder
authors: J
authors: Sharma
authors: Rashid
authors: R
authors: Al-Abri
mesh_terms: D000233:Adenoidectomy / Q000009:adverse effects / Q000379:methods*; D001049:Apnea / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D002091:Butyrylcholinesterase / Q000172:deficiency; D002675:Child, Preschool; D002802:Cholinesterases / Q000172:deficiency; D004342:Drug Hypersensitivity / Q000150:complications* / Q000175:diagnosis; D005500:Follow-Up Studies; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008297:Male; D008661:Metabolism, Inborn Errors; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology*; D035583:Rare Diseases; D012121:Respiration, Artificial; D018570:Risk Assessment; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000601:surgery; D013997:Time Factors; D014068:Tonsillectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D002091:Butyrylcholinesterase; D002802:Cholinesterases