title: Prolonged Paralysis Following Emergent Cesarean Section with Succinylcholine Despite Normal Dibucaine Number.
abstract: Prolonged paralysis due to a quantitative or qualitative deficiency of pseudocholinesterase activity is an uncommon but known side effect of succinylcholine. We describe a patient who experienced prolonged paralysis following administration of succinylcholine for general anesthesia and endotracheal intubation for an emergent cesarean section despite laboratory evidence of normal enzyme function. The patient required mechanical ventilation in the intensive care unit for several hours following surgery. The patient was extubated following return of full muscle strength and had a good outcome. The enzyme responsible for the metabolism of succinylcholine, pseudocholinesterase, was determined to be low in quantity in this patient but was functionally normal. This low level, by itself, was unlikely to be solely responsible for the prolonged paralysis. The patient likely had an abnormal pseudocholinesterase enzyme variant that is undetectable by standard laboratory tests.
authors.forename: Matthew
authors.initials: M
authors.lastname: Ellison
authors.forename: Brian
authors.initials: B
authors.lastname: Grose
authors.forename: Stephen
authors.initials: S
authors.lastname: Howell
authors.forename: Colin
authors.initials: C
authors.lastname: Wilson
authors.forename: Jackson
authors.initials: J
authors.lastname: Lenz
authors.forename: Richard
authors.initials: R
authors.lastname: Driver
mesh_terms: D000328:Adult; D000768:Anesthesia, General / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage; D002091:Butyrylcholinesterase / Q000097:blood / Q000172:deficiency; D002585:Cesarean Section; D003992:Dibucaine / Q000008:administration & dosage; D004630:Emergencies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects; D009467:Neuromuscular Depolarizing Agents / Q000008:administration & dosage / Q000009:adverse effects*; D007744:Obstetric Labor Complications / Q000139:chemically induced*; D010243:Paralysis / Q000139:chemically induced*; D011247:Pregnancy; D012121:Respiration, Artificial; D013390:Succinylcholine / Q000008:administration & dosage / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D009467:Neuromuscular Depolarizing Agents; D002091:Butyrylcholinesterase; D013390:Succinylcholine; D003992:Dibucaine