title: Recovery of residual curarization after red blood cell transfusion.
abstract: BACKGROUND
  The muscle-relaxing effects of succinylcholine are terminated via hydrolysis by plasma cholinesterase. There are multiple genetic variants of this enzyme and clinical circumstances that might influence the activity of plasma cholinesterase and eventually lead to prolonged neuromuscular blockade following succinylcholine application.
  
  
  METHODS
  Here, we report a parturient woman with atonic bleeding who suffered significant blood loss (hemoglobin 6.0 g•dL-¹). For surgical curettage, general anesthesia was performed by using short-acting succinylcholine. By the end of the 105-minute procedure, the patient's trachea was extubated. After extubation she showed signs of the prolonged neuromuscular blocking action of succinylcholine. At this time, the patient received an AB0-compatible red blood cell transfusion and recovered instantly from neuromuscular blockade. The plasma cholinesterase (3.200 U•L-¹) was below the normal range (4.900-12.000 U•L-¹). Patient's blood DNA analysis revealed heterozygously the genetic K variant of plasma cholinesterase. After red blood cell transfusion, serum potassium was elevated (5.7 mmol•L-¹; 4.4 mmol•L-¹ prior to transfusion).
  
  
  CONCLUSIONS
  Pregnancy, blood loss and genetic variation contributed to impairment of plasma cholinesterase. Due to high-speed red blood cell transfusion, hemolytic release of erythrocyte cholinesterase might have terminated the neuromuscular blocking succinylcholine effect.
authors.affiliation: Department of Anesthesiology and Intensive Care, Eberhard-Karls-University, Tuebingen, Germany. veit-simon.eckle@uni-tuebingen.de
authors.forename: Veit-Simon
authors.initials: VS
authors.lastname: Eckle
authors.forename: Eckhard
authors.initials: E
authors.lastname: Schmid
authors.forename: Tanja
authors.initials: T
authors.lastname: Fehm
authors.forename: Christian
authors.initials: C
authors.lastname: Grasshoff
mesh_terms: D000328:Adult; D002802:Cholinesterases / Q000097:blood; D003472:Curare / Q000378:metabolism*; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D019148:Neuromuscular Blockade; D011247:Pregnancy
chemical_list: D003472:Curare; D002802:Cholinesterases