Materiały źródłowe

• #1 Pseudocholinesterase Deficiency – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK541032/

  Pseudocholinesterase deficiency, also known as butyrylcholinesterase deficiency, refers to a rare acquired or inherited defect in the pseudocholinesterase enzyme produced by the liver. […] This activity reviews the evaluation and management of pseudocholinesterase deficiency, and highlights the role of the interprofessional team in managing patients with this condition. […] Explain the importance of improving care coordination amongst the interprofessional team to enhance the delivery of care for patients with pseudocholinesterase deficiency. […] The mainstay of treatment involves respiratory support with mechanical ventilation until the spontaneous resolution of neuromuscular blockade. […] Management for those previously diagnosed with pseudocholinesterase deficiency includes the avoidance of depolarizing the neuromuscular blocker succinylcholine and the non-depolarizing muscular blocker mivacurium.

• #2 Pseudocholinesterase Deficiency and Patient Perspectives

  https://clinmedjournals.org/articles/ijaa/international-journal-of-anesthetics-and-anesthesiology-ijaa-8-124.php

  Pseudocholinesterase deficiency, commonly referred to as Butyrylcholinesterase deficiency, is a rare, inherited, or acquired condition that results in decreased or absent enzymatic activity. […] Treatment is mainly supportive with continued mechanical ventilation until return of muscle function because paralysis can last from minutes to hours and re-sedation to limit patient discomfort. […] The mainstay of treatment is continued mechanical ventilation with sedation and continued peripheral nerve monitoring until paralysis ends and spontaneity of muscle activity returns. […] To prevent future incidence of prolonged paralysis, patients with pseudocholinesterase deficiency should avoid succinylcholine and mivacurium. […] It is imperative that patients are re-sedated in a timely manner to limit patient discomfort. […] Pseudocholinesterase deficiency is inherited in an autosomal recessive manner; however, given the large genetic component, it is recommended that immediate family members get tested.

• #3 Digital Commons @ Otterbein

  https://digitalcommons.otterbein.edu/stu_msn/56/

  Pseudocholinesterase deficiency is a rare genetic or acquired variation in the metabolism of choline esters such as the neuromuscular blockers succinylcholine, mivacurium, and ester local anesthetics. […] This condition is rare but must be known and understood by the clinician in order to provide the safest patient care possible. […] The purpose of this discussion is to further educate the practitioner on the pathophysiology of pseudocholinesterase deficiency, as well as signs and symptoms, and patient management strategies to improve patient outcomes.

• #4 Residual Muscle Weakness after Succinylcholine Infusion: Clinical Presentation, Diagnosis and Treatment

  https://austinpublishinggroup.com/anesthesia-analgesia/fulltext/ajaa-v2-id1022.php

  Pseudocholinesterase deficiency is synthesized by the liver and exists in plasma. It breaks down Succinylcholine to inactive metabolites. […] The lab results of the 2nd patient did show decreased pseudocholinesterase level (though dubicaine number is unavailable), which indicated decreased enzyme quantity. […] The presence of chronic malignancy increases the likelihood of pseudocholinesterase abnormality, including both quality and quantity, not to mention the possibility of genetic variant of pseudocholinesterase. […] The detection of decreased pseudocholinesterase level may warrant further lab test such as dubicaine number or genetic test for pseudocholinesterase. […] It is prudent to apply neuromuscular monitoring (such as acceleromyography with train-of-four nerve stimulation) during succinylcholine infusion even when the surgery is considered a short procedure.

• #5 Pseudocholinesterase deficiency – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudocholinesterase-deficiency/diagnosis-treatment/drc-20354545

  Pseudocholinesterase deficiency may be suspected when you have problems recovering muscle control and breathing after you get the muscle relaxant succinylcholine as part of anesthesia. […] If you have pseudocholinesterase deficiency, the health care provider who gives you anesthesia (anesthesiologist) can avoid succinylcholine that may trigger prolonged muscle relaxation. […] There is no cure for pseudocholinesterase deficiency. If you have the disorder and you receive a muscle relaxant that prolongs your anesthesia recovery, you’ll likely need medical assistance. […] If you’ve been diagnosed with pseudocholinesterase deficiency, wear a medical alert bracelet or necklace and carry a wallet card. This lets health care professionals know of your risk, especially in an emergency.

• #6 Pseudocholinesterase Deficiency – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK541032/

  Pseudocholinesterase deficiency is a clinical condition that is often only discovered after exposure to succinylcholine or mivacurium. […] Patients diagnosed with pseudocholinesterase deficiency after exposure to succinylcholine or mivacurium are expected to make a full recovery, following the spontaneous return of motor function. […] Individuals diagnosed with pseudocholinesterase deficiency should inform their doctor and anesthesia provider of their condition before any surgery. […] Future anesthetics should avoid administration of succinylcholine and mivacurium to avoid prolonged neuromuscular blockade and possibly respiratory failure. […] While a rare condition, pseudocholinesterase deficiency is best addressed via an interprofessional healthcare team approach, with physicians, specialists, specialty trained nursing staff, and pharmacists, working and communicating to achieve the best possible patient outcomes.

• #7 Pseudocholinesterase deficiency | Altru Health System

  https://www.altru.org/health-library/conditions/pseudocholinesterase-deficiency

  Pseudocholinesterase deficiency is a rare disorder that makes you sensitive to certain muscle relaxants succinylcholine or mivacurium used during general anesthesia. […] With pseudocholinesterase deficiency, the body muscles stay relaxed for a longer time than expected. […] This temporary loss of the ability to move your muscles (paralysis) makes you unable to breathe or move on your own. […] You may need help breathing with a mechanical ventilator until you can start breathing on your own. […] But if you’re diagnosed with the disorder, your health care provider can use other types of muscle relaxants that won’t cause muscle paralysis that lasts longer than expected. […] Signs and symptoms of pseudocholinesterase deficiency include muscle relaxation or muscle paralysis that lasts several hours longer than expected.

• #8 Hereditary pseudocholinesterase deficiency in a 4-year-old girl: a case report | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-025-05183-5

  Pseudocholinesterase deficiency is an important, albeit rare, differential diagnosis of delayed emergence from general anesthesia. Insufficient enzyme activity alters the metabolism of choline esters, such as succinylcholine and mivacurium, and patients typically present with prolonged post-anesthetic apnea and paralysis. […] Pseudocholinesterase deficiency will almost always present unexpectedly and must be included in the differential diagnosis of delayed emergence. Once suspected, a clinical diagnosis can be supported using a peripheral nerve stimulator, and confirmed using laboratory tests. Genetic testing can help determine the etiology of disease. […] Evaluation of patients neuromuscular status using a peripheral nerve stimulator should routinely be performed following administration of mivacurium or succinylcholine. It is a simple, quick, reliable, and inexpensive way of ensuring that pseudocholinesterase deficiency will not be overlooked.

• #9 Pseudocholinesterase Deficiency – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK541032/

  Pseudocholinesterase deficiency, also known as butyrylcholinesterase deficiency, refers to a rare acquired or inherited defect in the pseudocholinesterase enzyme produced by the liver. […] This activity reviews the evaluation and management of pseudocholinesterase deficiency, and highlights the role of the interprofessional team in managing patients with this condition. […] Explain the importance of improving care coordination amongst the interprofessional team to enhance the delivery of care for patients with pseudocholinesterase deficiency. […] The mainstay of treatment involves respiratory support with mechanical ventilation until the spontaneous resolution of neuromuscular blockade. […] Management for those previously diagnosed with pseudocholinesterase deficiency includes the avoidance of depolarizing the neuromuscular blocker succinylcholine and the non-depolarizing muscular blocker mivacurium.

• #10 Pseudocholinesterase Deficiency | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27928

  Pseudocholinesterase deficiency can be acquired and/or be inherited. […] Individuals with pseudocholinesterase deficiency are often only diagnosed after experiencing prolonged neuromuscular paralysis following standard doses of succinylcholine and mivacurium. The mainstay of treatment involves respiratory support with mechanical ventilation until the spontaneous resolution of neuromuscular blockade. […] Management for those previously diagnosed with pseudocholinesterase deficiency includes the avoidance of depolarizing the neuromuscular blocker succinylcholine and the non-depolarizing muscular blocker mivacurium. Other nondepolarizing neuromuscular blockers such as atracurium, rocuronium, and vecuronium safe for use in future anesthetics. […] Individuals diagnosed with pseudocholinesterase deficiency should inform their doctor and anesthesia provider of their condition before any surgery. The patient’s medical record should be updated to reflect the diagnosis of pseudocholinesterase deficiency. Future anesthetics should avoid administration of succinylcholine and mivacurium to avoid prolonged neuromuscular blockade and possibly respiratory failure. […] Pseudocholinesterase deficiency is best addressed via an interprofessional healthcare team approach, with physicians, specialists, specialty trained nursing staff, and pharmacists, working and communicating to achieve the best possible patient outcomes.

• #11 Pseudocholinesterase Deficiency and Patient Perspectives

  https://clinmedjournals.org/articles/ijaa/international-journal-of-anesthetics-and-anesthesiology-ijaa-8-124.php

  Pseudocholinesterase deficiency, commonly referred to as Butyrylcholinesterase deficiency, is a rare, inherited, or acquired condition that results in decreased or absent enzymatic activity. […] Treatment is mainly supportive with continued mechanical ventilation until return of muscle function because paralysis can last from minutes to hours and re-sedation to limit patient discomfort. […] The mainstay of treatment is continued mechanical ventilation with sedation and continued peripheral nerve monitoring until paralysis ends and spontaneity of muscle activity returns. […] To prevent future incidence of prolonged paralysis, patients with pseudocholinesterase deficiency should avoid succinylcholine and mivacurium. […] It is imperative that patients are re-sedated in a timely manner to limit patient discomfort. […] Pseudocholinesterase deficiency is inherited in an autosomal recessive manner; however, given the large genetic component, it is recommended that immediate family members get tested.

• #12 Pseudocholinesterase Deficiency Treatment & Management: Medical Care

  https://emedicine.medscape.com/article/247019-treatment

  Patients with prolonged paralysis following administration of succinylcholine can be treated in the following ways: […] Mechanical ventilatory support is the mainstay of treatment until respiratory muscle paralysis spontaneously resolves. Recovery eventually occurs as a result of passive diffusion of succinylcholine away from the neuromuscular junction. […] Consultation with a geneticist may help identify the specific atypical genotype alleles contributing to pseudocholinesterase deficiency. […] Because the DNA sequence of the pseudocholinesterase gene and its amino acid structure is known, atypical alleles now can be identified by polymerase chain reaction (PCR) amplification studies using DNA extracted from leukocytes in a blood sample.

• #13 Pseudocholinesterase Deficiency and Patient Perspectives

  https://clinmedjournals.org/articles/ijaa/international-journal-of-anesthetics-and-anesthesiology-ijaa-8-124.php

  Pseudocholinesterase deficiency, commonly referred to as Butyrylcholinesterase deficiency, is a rare, inherited, or acquired condition that results in decreased or absent enzymatic activity. […] Treatment is mainly supportive with continued mechanical ventilation until return of muscle function because paralysis can last from minutes to hours and re-sedation to limit patient discomfort. […] The mainstay of treatment is continued mechanical ventilation with sedation and continued peripheral nerve monitoring until paralysis ends and spontaneity of muscle activity returns. […] To prevent future incidence of prolonged paralysis, patients with pseudocholinesterase deficiency should avoid succinylcholine and mivacurium. […] It is imperative that patients are re-sedated in a timely manner to limit patient discomfort. […] Pseudocholinesterase deficiency is inherited in an autosomal recessive manner; however, given the large genetic component, it is recommended that immediate family members get tested.

• #14 What Is Pseudocholinesterase Deficiency?

  https://www.icliniq.com/articles/genetic-disorders/pseudocholinesterase-deficiency

  The mainstay of treatment in these patients is to continue mechanical ventilation with sedation and continue peripheral nerve monitoring until paralysis ends and the muscle activity returns to normal. […] Note: Patients with pseudocholinesterase deficiency should avoid drugs like Succinylcholine and Mivacurium to prevent the future occurrence of prolonged paralysis. […] Patients suffering from Pseudocholinesterase deficiency should also be properly educated about the adverse reactions of these drugs.

• #15 Pseudocholinesterase Deficiency – MD Searchlight

  https://mdsearchlight.com/health/pseudocholinesterase-deficiency/

  For those patients who have already been diagnosed with pseudocholinesterase deficiency, the approach is to avoid using the drugs succinylcholine and mivacurium, which block nerve signals to muscles. Instead, doctors recommend using other safe alternatives for future anesthetic procedures such as atracurium, rocuronium, and vecuronium. […] If you have been diagnosed with a condition called pseudocholinesterase deficiency, its vital to inform your doctor and the person who gives you anesthesia before any surgery. This is because your condition needs to be recorded in your medical history. […] Pseudocholinesterase deficiency is treated with respiratory support using a mechanical ventilator and sedation to reduce anxiety. Nerve stimulation is used to check if muscle function is returning. The preferred treatment approach is to provide support with sedation and mechanical ventilation until recovery takes place, which usually occurs within several hours. This approach is considered less risky than alternatives such as transfusion of plasma or the use of other medications to reverse the paralysis, which have proven to be unreliable.

• #16 Residual Muscle Weakness after Succinylcholine Infusion: Clinical Presentation, Diagnosis and Treatment

  https://austinpublishinggroup.com/anesthesia-analgesia/fulltext/ajaa-v2-id1022.php

  Pseudocholinesterase deficiency is synthesized by the liver and exists in plasma. It breaks down Succinylcholine to inactive metabolites. […] The lab results of the 2nd patient did show decreased pseudocholinesterase level (though dubicaine number is unavailable), which indicated decreased enzyme quantity. […] The presence of chronic malignancy increases the likelihood of pseudocholinesterase abnormality, including both quality and quantity, not to mention the possibility of genetic variant of pseudocholinesterase. […] The detection of decreased pseudocholinesterase level may warrant further lab test such as dubicaine number or genetic test for pseudocholinesterase. […] It is prudent to apply neuromuscular monitoring (such as acceleromyography with train-of-four nerve stimulation) during succinylcholine infusion even when the surgery is considered a short procedure.

• #17 Hereditary pseudocholinesterase deficiency in a 4-year-old girl: a case report | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-025-05183-5

  Pseudocholinesterase deficiency is an important, albeit rare, differential diagnosis of delayed emergence from general anesthesia. Insufficient enzyme activity alters the metabolism of choline esters, such as succinylcholine and mivacurium, and patients typically present with prolonged post-anesthetic apnea and paralysis. […] Pseudocholinesterase deficiency will almost always present unexpectedly and must be included in the differential diagnosis of delayed emergence. Once suspected, a clinical diagnosis can be supported using a peripheral nerve stimulator, and confirmed using laboratory tests. Genetic testing can help determine the etiology of disease. […] Evaluation of patients neuromuscular status using a peripheral nerve stimulator should routinely be performed following administration of mivacurium or succinylcholine. It is a simple, quick, reliable, and inexpensive way of ensuring that pseudocholinesterase deficiency will not be overlooked.

• #18 Pseudocholinesterase Deficiency | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27928

  Pseudocholinesterase deficiency can be acquired and/or be inherited. […] Individuals with pseudocholinesterase deficiency are often only diagnosed after experiencing prolonged neuromuscular paralysis following standard doses of succinylcholine and mivacurium. The mainstay of treatment involves respiratory support with mechanical ventilation until the spontaneous resolution of neuromuscular blockade. […] Management for those previously diagnosed with pseudocholinesterase deficiency includes the avoidance of depolarizing the neuromuscular blocker succinylcholine and the non-depolarizing muscular blocker mivacurium. Other nondepolarizing neuromuscular blockers such as atracurium, rocuronium, and vecuronium safe for use in future anesthetics. […] Individuals diagnosed with pseudocholinesterase deficiency should inform their doctor and anesthesia provider of their condition before any surgery. The patient’s medical record should be updated to reflect the diagnosis of pseudocholinesterase deficiency. Future anesthetics should avoid administration of succinylcholine and mivacurium to avoid prolonged neuromuscular blockade and possibly respiratory failure. […] Pseudocholinesterase deficiency is best addressed via an interprofessional healthcare team approach, with physicians, specialists, specialty trained nursing staff, and pharmacists, working and communicating to achieve the best possible patient outcomes.

• #19 Pseudocholinesterase Deficiency – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK541032/

  Pseudocholinesterase deficiency, also known as butyrylcholinesterase deficiency, refers to a rare acquired or inherited defect in the pseudocholinesterase enzyme produced by the liver. This activity reviews the evaluation and management of pseudocholinesterase deficiency, and highlights the role of the interprofessional team in managing patients with this condition. […] Explain the importance of improving care coordination amongst the interprofessional team to enhance the delivery of care for patients with pseudocholinesterase deficiency. […] The mainstay of treatment involves respiratory support with mechanical ventilation until the spontaneous resolution of neuromuscular blockade. […] Management for those previously diagnosed with pseudocholinesterase deficiency includes the avoidance of depolarizing the neuromuscular blocker succinylcholine and the non-depolarizing muscular blocker mivacurium. […] Pseudocholinesterase deficiency is best addressed via an interprofessional healthcare team approach, with physicians, specialists, specialty trained nursing staff, and pharmacists, working and communicating to achieve the best possible patient outcomes.

• #20 Pseudocholinesterase deficiency // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/pseudocholinesterase-deficiency

  Pseudocholinesterase deficiency can be caused by a gene change (mutation) that is inherited. […] There is no cure for pseudocholinesterase deficiency. But if you’re diagnosed with the disorder, your health care provider can use other types of muscle relaxants that won’t cause muscle paralysis that lasts longer than expected. […] If you have pseudocholinesterase deficiency, the health care provider who gives you anesthesia (anesthesiologist) can avoid succinylcholine that may trigger prolonged muscle relaxation. The anesthesiologist can choose other muscle relaxants instead. […] If you have the disorder and you receive a muscle relaxant that prolongs your anesthesia recovery, you’ll likely need medical assistance. If needed, a machine that takes over the work of breathing (mechanical ventilation support) and sedation are provided while you recover and start breathing on your own. This may take several hours. […] If you’ve been diagnosed with pseudocholinesterase deficiency, wear a medical alert bracelet or necklace and carry a wallet card. This lets health care professionals know of your risk, especially in an emergency.

• #21 Mayo Clinic Health Library – Pseudocholinesterase deficiency | Swiss Medical Network

  https://www.swissmedical.net/de/healtcare-library/con-20200770

  If you have the disorder and you receive a muscle relaxant that prolongs your anesthesia recovery, you’ll likely need medical assistance. If needed, a machine that takes over the work of breathing (mechanical ventilation support) and sedation are provided while you recover and start breathing on your own. This may take several hours. […] If you’ve been diagnosed with pseudocholinesterase deficiency, wear a medical alert bracelet or necklace and carry a wallet card. This lets health care professionals know of your risk, especially in an emergency.

• #22 Pseudocholinesterase deficiency | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/pseudocholinesterase-deficiency?content_id=CON-20200770

  This causes sensitivity to certain muscle relaxants used during anesthesia. Muscles may stay relaxed for too long, interfering with movement and breathing. […] If you have pseudocholinesterase deficiency, the health care provider who gives you anesthesia (anesthesiologist) can avoid succinylcholine that may trigger prolonged muscle relaxation. The anesthesiologist can choose other muscle relaxants instead. […] There is no cure for pseudocholinesterase deficiency. If you have the disorder and you receive a muscle relaxant that prolongs your anesthesia recovery, you’ll likely need medical assistance. If needed, a machine that takes over the work of breathing (mechanical ventilation support) and sedation are provided while you recover and start breathing on your own. This may take several hours. […] If you’ve been diagnosed with pseudocholinesterase deficiency, wear a medical alert bracelet or necklace and carry a wallet card. This lets health care professionals know of your risk, especially in an emergency.

• #23 Pseudocholinesterase Deficiency – MD Searchlight

  https://mdsearchlight.com/health/pseudocholinesterase-deficiency/

  Pseudocholinesterase deficiency is a rare condition that can be inherited or acquired. Its a defect in an enzyme produced by the liver called pseudocholinesterase. […] People with pseudocholinesterase deficiency are usually diagnosed after they experience extended muscle paralysis after having standard doses of certain medications like succinylcholine and mivacurium. The main treatment for this condition is respiratory support with the help of a mechanical ventilator. This system helps the patient breathe until their own muscle function begins to recover naturally. […] The preferred treatment is to provide support with sedation (medications to help the patient relax or sleep) and mechanical ventilation (machine-assisted breathing), until recovery takes place usually occurring within several hours.

• #24 Pseudocholinesterase Deficiency – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK541032/

  Pseudocholinesterase deficiency is a clinical condition that is often only discovered after exposure to succinylcholine or mivacurium. […] Patients diagnosed with pseudocholinesterase deficiency after exposure to succinylcholine or mivacurium are expected to make a full recovery, following the spontaneous return of motor function. […] Individuals diagnosed with pseudocholinesterase deficiency should inform their doctor and anesthesia provider of their condition before any surgery. […] Future anesthetics should avoid administration of succinylcholine and mivacurium to avoid prolonged neuromuscular blockade and possibly respiratory failure. […] While a rare condition, pseudocholinesterase deficiency is best addressed via an interprofessional healthcare team approach, with physicians, specialists, specialty trained nursing staff, and pharmacists, working and communicating to achieve the best possible patient outcomes.

• #25 What Is Pseudocholinesterase Deficiency?

  https://www.icliniq.com/articles/genetic-disorders/pseudocholinesterase-deficiency

  The mainstay of treatment in these patients is to continue mechanical ventilation with sedation and continue peripheral nerve monitoring until paralysis ends and the muscle activity returns to normal. […] Note: Patients with pseudocholinesterase deficiency should avoid drugs like Succinylcholine and Mivacurium to prevent the future occurrence of prolonged paralysis. […] Patients suffering from Pseudocholinesterase deficiency should also be properly educated about the adverse reactions of these drugs.

• #26 Decoding Pseudocholinesterase Deficiency: Understanding, Diagnosing, and the Role of Genetic Testing

  https://sequencing.com/education-center/medical/pseudocholinesterase-deficiency?srsltid=AfmBOooYUnjnddphvIosCPF0PA1nFCYIUgxdfGdNjueSQxcNyjAtlKPZ

  Understanding, diagnosing, and managing pseudocholinesterase deficiency is essential for healthcare providers to ensure the safety and well-being of their patients. Genetic testing plays a crucial role in identifying the genetic causes of the condition, developing animal models for research, and screening and counseling at-risk individuals.

• #27 Pseudocholinesterase Deficiency: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/pseudocholinesterase-deficiency

  If you have a pseudocholinesterase deficiency diagnosis, you should avoid certain anesthetic medications, including: Succinylcholine, Mivacurium, Procaine, Chloroprocaine, Benzocaine, Tetracaine. […] If you receive a pseudocholinesterase deficiency diagnosis, letting your healthcare providers know is the best thing you can do especially those you see for surgical procedures.

• #28 Pseudocholinesterase Deficiency | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27928

  Pseudocholinesterase deficiency can be acquired and/or be inherited. […] Individuals with pseudocholinesterase deficiency are often only diagnosed after experiencing prolonged neuromuscular paralysis following standard doses of succinylcholine and mivacurium. The mainstay of treatment involves respiratory support with mechanical ventilation until the spontaneous resolution of neuromuscular blockade. […] Management for those previously diagnosed with pseudocholinesterase deficiency includes the avoidance of depolarizing the neuromuscular blocker succinylcholine and the non-depolarizing muscular blocker mivacurium. Other nondepolarizing neuromuscular blockers such as atracurium, rocuronium, and vecuronium safe for use in future anesthetics. […] Individuals diagnosed with pseudocholinesterase deficiency should inform their doctor and anesthesia provider of their condition before any surgery. The patient’s medical record should be updated to reflect the diagnosis of pseudocholinesterase deficiency. Future anesthetics should avoid administration of succinylcholine and mivacurium to avoid prolonged neuromuscular blockade and possibly respiratory failure. […] Pseudocholinesterase deficiency is best addressed via an interprofessional healthcare team approach, with physicians, specialists, specialty trained nursing staff, and pharmacists, working and communicating to achieve the best possible patient outcomes.

• #29 Pseudocholinesterase deficiency

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20200770

  Pseudocholinesterase deficiency can be caused by a gene change (mutation) that is inherited. […] There is no cure for pseudocholinesterase deficiency. But if you’re diagnosed with the disorder, your health care provider can use other types of muscle relaxants that won’t cause muscle paralysis that lasts longer than expected. […] If you have pseudocholinesterase deficiency, the health care provider who gives you anesthesia (anesthesiologist) can avoid succinylcholine that may trigger prolonged muscle relaxation. The anesthesiologist can choose other muscle relaxants instead. […] If needed, a machine that takes over the work of breathing (mechanical ventilation support) and sedation are provided while you recover and start breathing on your own. This may take several hours. […] If you’ve been diagnosed with pseudocholinesterase deficiency, wear a medical alert bracelet or necklace and carry a wallet card. This lets health care professionals know of your risk, especially in an emergency.

• #30 Pseudocholinesterase deficiency

  https://ask-ahd.ahdubai.com/con-20200770

  This causes sensitivity to certain muscle relaxants used during anesthesia. Muscles may stay relaxed for too long, interfering with movement and breathing. […] Pseudocholinesterase deficiency causes the muscles to stay relaxed for too long, which prevents you from moving or breathing on your own for a few hours after receiving the drug. […] If you have pseudocholinesterase deficiency, your anesthesiologist can avoid giving you drugs that may trigger prolonged muscle relaxation and choose other muscle relaxants instead. […] There is no cure for pseudocholinesterase deficiency. If you have the condition and you receive muscle relaxants that prolong your anesthesia recovery, you’ll likely need medical assistance. If needed, mechanical ventilation support and sedation are provided while you recover and start breathing on your own. […] If you’ve been diagnosed with pseudocholinesterase deficiency, wear a medical alert bracelet or necklace. This lets health care professionals know of your risk, especially in an emergency.

• #31

  https://cacgas.com/forms

  1) Add „Pseudocholinesterase deficiency” to the „Allergies” of the patient. This will ensure it follows patient throughout hospitalization. It will also be added to their wrist band for this, and future admissions. […] 2) Launch the „Psudocholinesterase deficiency” order set: This will instruct nursing to give a copy of the” „PROLONGED NMB letter” to the patient (family) on discharge, and also add a copy of the letter to the chart. […] 3) Complete and print the PROLONGED NMB LETTER. […] At surgery Centers, please complete the PROLONGED NMB LETTER, and give one copy to patient, one copy for chart.

• #32 AANA Journal June 2016: Unknown Pseudocholinesterase Deficiency in a Patient Undergoing TIVA with Planned Motor Evoked Potential Monitoring: A Case Report

  http://www.onlinedigeditions.com/article/Unknown+Pseudocholinesterase+Deficiency+in+a+Patient+Undergoing+TIVA+with+Planned+Motor+Evoked+Potential+Monitoring%3A+A+Case+Report/2493563/304411/article.html

  Pseudocholinesterase abnormalities are a genetic cause of aberrant metabolism of the depolarizing muscle relaxant succinylcholine. […] This case study highlights the intraoperative and postoperative management of an elderly patient with an unknown pseudocholinesterase deficiency. […] In the presence of an unknown pseudocholinesterase deficiency, the duration of paralysis after succinylcholine administration may be significantly increased, resulting in the inability to monitor evoked potentials. […] The lack of response led to a presumptive diagnosis of pseudocholinesterase deficiency. […] The patient was educated regarding his atypical enzyme and given a letter regarding his pseudocholinesterase deficiency for future anesthesia experiences. […] The inability to elicit a TOF response led the student registered nurse anesthetist to an early presumptive diagnosis of pseudocholinesterase deficiency.

• #33 Pseudocholinesterase Deficiency – Acibadem Health Point – ACIBADEM Hospitals – Acibadem Health Group

  https://www.acibademhealthpoint.com/cat/health-library/pseudocholinesterase-deficiency/

  Managing pseudocholinesterase deficiency needs a plan made just for each person. Doctors and patients work together to create a care plan. This plan helps tackle the unique challenges of this rare condition. […] Before surgery, patients must tell their anesthesiologists about their condition. This helps the medical team choose the right anesthetics and watch the patient closely during and after surgery. […] After surgery, postoperative monitoring is key for these patients. They might need to stay in the post-anesthesia care unit (PACU) longer to fully recover. Monitoring should include checks on breathing, oxygen levels, and muscle strength. […] Understanding the anesthetic implications of pseudocholinesterase deficiency helps healthcare providers give safe and effective care. This is important for patients during surgical procedures.

• #34 Pseudocholinesterase Deficiency and Patient Perspectives

  https://clinmedjournals.org/articles/ijaa/international-journal-of-anesthetics-and-anesthesiology-ijaa-8-124.php

  Pseudocholinesterase deficiency, commonly referred to as Butyrylcholinesterase deficiency, is a rare, inherited, or acquired condition that results in decreased or absent enzymatic activity. […] Treatment is mainly supportive with continued mechanical ventilation until return of muscle function because paralysis can last from minutes to hours and re-sedation to limit patient discomfort. […] The mainstay of treatment is continued mechanical ventilation with sedation and continued peripheral nerve monitoring until paralysis ends and spontaneity of muscle activity returns. […] To prevent future incidence of prolonged paralysis, patients with pseudocholinesterase deficiency should avoid succinylcholine and mivacurium. […] It is imperative that patients are re-sedated in a timely manner to limit patient discomfort. […] Pseudocholinesterase deficiency is inherited in an autosomal recessive manner; however, given the large genetic component, it is recommended that immediate family members get tested.

• #35

  https://journals.lww.com/jica/fulltext/2022/01020/revisiting_pseudocholinesterase_deficiency__the.1.aspx

  This issue describes an interesting case of an unusual presentation of pseudocholinesterase (PChE) deficiency in a parturient undergoing emergent cesarean section by Upadaya and Garg. […] It is thus important to revisit PChE deficiency, and start a conversation on this life-threatening but relatively easy-to-manage complication following succinylcholine administration. […] Although PChE deficiency is a rare disorder, it is a serious condition since it is difficult to diagnose clinically preoperatively and can be potentially fatal. However, when diagnosed, it is treatable with ventilatory support till spontaneous recovery. […] A thorough preoperative evaluation can guide the anesthesiologist to the possibility of PChE deficiency. […] It is, therefore, prudent that a detailed preoperative evaluation for any suggestive history or acquired causes of PChE deficiency should be done. Keep a high index of suspicion in the event of delayed or inadequate recovery from neuromuscular block. Plasma enzyme assay will help confirm the diagnosis. […] Patients diagnosed with PChE deficiency are expected to make a full recovery after administration of succinylcholine or mivacurium provided adequate mechanical ventilation and vigilant monitoring is provided to ensure the spontaneous return of motor function.

• #36 Pseudocholinesterase deficiency // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/pseudocholinesterase-deficiency

  Pseudocholinesterase deficiency can be caused by a gene change (mutation) that is inherited. […] There is no cure for pseudocholinesterase deficiency. But if you’re diagnosed with the disorder, your health care provider can use other types of muscle relaxants that won’t cause muscle paralysis that lasts longer than expected. […] If you have pseudocholinesterase deficiency, the health care provider who gives you anesthesia (anesthesiologist) can avoid succinylcholine that may trigger prolonged muscle relaxation. The anesthesiologist can choose other muscle relaxants instead. […] If you have the disorder and you receive a muscle relaxant that prolongs your anesthesia recovery, you’ll likely need medical assistance. If needed, a machine that takes over the work of breathing (mechanical ventilation support) and sedation are provided while you recover and start breathing on your own. This may take several hours. […] If you’ve been diagnosed with pseudocholinesterase deficiency, wear a medical alert bracelet or necklace and carry a wallet card. This lets health care professionals know of your risk, especially in an emergency.

• #37 Pseudocholinesterase Deficiency – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK541032/

  Pseudocholinesterase deficiency, also known as butyrylcholinesterase deficiency, refers to a rare acquired or inherited defect in the pseudocholinesterase enzyme produced by the liver. This activity reviews the evaluation and management of pseudocholinesterase deficiency, and highlights the role of the interprofessional team in managing patients with this condition. […] Explain the importance of improving care coordination amongst the interprofessional team to enhance the delivery of care for patients with pseudocholinesterase deficiency. […] The mainstay of treatment involves respiratory support with mechanical ventilation until the spontaneous resolution of neuromuscular blockade. […] Management for those previously diagnosed with pseudocholinesterase deficiency includes the avoidance of depolarizing the neuromuscular blocker succinylcholine and the non-depolarizing muscular blocker mivacurium. […] Pseudocholinesterase deficiency is best addressed via an interprofessional healthcare team approach, with physicians, specialists, specialty trained nursing staff, and pharmacists, working and communicating to achieve the best possible patient outcomes.

• #38 Pseudocholinesterase Deficiency | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27928

  Pseudocholinesterase deficiency can be acquired and/or be inherited. […] Individuals with pseudocholinesterase deficiency are often only diagnosed after experiencing prolonged neuromuscular paralysis following standard doses of succinylcholine and mivacurium. The mainstay of treatment involves respiratory support with mechanical ventilation until the spontaneous resolution of neuromuscular blockade. […] Management for those previously diagnosed with pseudocholinesterase deficiency includes the avoidance of depolarizing the neuromuscular blocker succinylcholine and the non-depolarizing muscular blocker mivacurium. Other nondepolarizing neuromuscular blockers such as atracurium, rocuronium, and vecuronium safe for use in future anesthetics. […] Individuals diagnosed with pseudocholinesterase deficiency should inform their doctor and anesthesia provider of their condition before any surgery. The patient’s medical record should be updated to reflect the diagnosis of pseudocholinesterase deficiency. Future anesthetics should avoid administration of succinylcholine and mivacurium to avoid prolonged neuromuscular blockade and possibly respiratory failure. […] Pseudocholinesterase deficiency is best addressed via an interprofessional healthcare team approach, with physicians, specialists, specialty trained nursing staff, and pharmacists, working and communicating to achieve the best possible patient outcomes.

• #39 SMA Abstract: Pseudocholinesterase Deficiency: A Case Study

  https://sma.org/abstracts/pseudocholinesterase-deficiency/

  Upon completion of this lecture, learners should be better prepared to: describe the management of patients with pseudocholinesterase deficiency; […] Upon completion of this lecture, learners should be better prepared to: explain the importance of identifying patients with pseudocholinesterase deficiency. […] It is important to quickly recognize this rare condition as patient care post-surgery will need to include mechanical ventilation until the medication has been fully metabolized. […] Management of pseudocholinesterase deficiency is typically conservative treatment.

• #40

  https://www.apicareonline.com/index.php/APIC/article/view/296

  The management of an undetected pseudocholinesterase deficiency in a parturient who underwent urgent cesarean section has been presented. […] Upon persistent prolonged neuromuscular blockade sugammadex was administered. […] the importance of suspecting pseudocholinesterase deficiency and the need of neuromuscular monitoring have been argued in this case report.

• #41

  https://arsiv.dusunenadamdergisi.org/ing/fArticledetails4370.html?MkID=1286

  Pseudocholinesterase (PCE) deficiency is an inherited condition in which recovery from anesthetic agents like succinylcholine and mivacurium is slow and complicated by prolonged paralysis of respiratory muscles in susceptible patients. […] Since the measurement of PCE levels of all patients eligible for ECT is part of our pre-ECT assessment procedure, we could detect the deficiency before the ECT procedure. […] We suggest further investigation of this topic because screening for PCE levels in pre-ECT assessment may reduce complications of modified ECT with anesthesia. […] Detection of patients’ serum pseudocholinesterase levels is part of our routine preoperative laboratory workup. […] The PCE level of the patient in the case outlined above was the lowest of the values we have ever detected in our ECT center, and as far as we know it was the lowest value reported in the ECT literature.

• #42 Pseudocholinesterase Deficiency Treatment & Management: Medical Care

  https://emedicine.medscape.com/article/247019-treatment

  Patients with prolonged paralysis following administration of succinylcholine can be treated in the following ways: […] Mechanical ventilatory support is the mainstay of treatment until respiratory muscle paralysis spontaneously resolves. Recovery eventually occurs as a result of passive diffusion of succinylcholine away from the neuromuscular junction. […] Consultation with a geneticist may help identify the specific atypical genotype alleles contributing to pseudocholinesterase deficiency. […] Because the DNA sequence of the pseudocholinesterase gene and its amino acid structure is known, atypical alleles now can be identified by polymerase chain reaction (PCR) amplification studies using DNA extracted from leukocytes in a blood sample.

• #43 Pseudocholinesterase Deficiency: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/pseudocholinesterase-deficiency

  Pseudocholinesterase deficiency is a condition that makes a person extremely sensitive to certain anesthetic medications. People with pseudocholinesterase deficiency may not be able to move or breathe on their own for several hours after receiving these medications. Mechanical ventilation supports your breathing until you recover. […] If you receive general anesthesia and develop symptoms of pseudocholinesterase deficiency, you’ll likely need immediate medical care. Your healthcare team will monitor you while you recover. If necessary, they’ll keep you under anesthesia and use mechanical ventilation to help you breathe until you can breathe on your own again. […] You can’t prevent inherited pseudocholinesterase deficiency. But if it runs in your family, you can get tested for the BCHE gene mutation before undergoing general anesthesia. This can help you avoid surgical complications.

• #44 Decoding Pseudocholinesterase Deficiency: Understanding, Diagnosing, and the Role of Genetic Testing

  https://sequencing.com/education-center/medical/pseudocholinesterase-deficiency?srsltid=AfmBOooYUnjnddphvIosCPF0PA1nFCYIUgxdfGdNjueSQxcNyjAtlKPZ

  Pseudocholinesterase deficiency is a rare genetic disorder that affects the bodys ability to break down certain drugs, such as muscle relaxants used during anesthesia. This can lead to prolonged neuromuscular block and other complications. […] Understanding, diagnosing, and managing this condition is essential for healthcare providers, especially in the context of surgical procedures. […] For patients with known or suspected pseudocholinesterase deficiency, it is crucial to carefully manage their post-operative care. This may include maintaining intubated status until the patients ability to draw proper tidal volumes returns. Additionally, healthcare providers should be aware of alternative anesthetic agents that can be used in patients with this condition. […] Genetic testing can help identify the specific gene mutations responsible for pseudocholinesterase deficiency. This can be particularly useful for individuals with a family history of the condition or those who have experienced prolonged neuromuscular block after anesthesia. Knowing the genetic cause can help healthcare providers make informed decisions about anesthesia management and post-operative care.

• #45 Pseudocholinesterase Deficiency – Acibadem Health Point – ACIBADEM Hospitals – Acibadem Health Group

  https://www.acibademhealthpoint.com/cat/health-library/pseudocholinesterase-deficiency/

  Its very important to manage anesthesia carefully for pregnant women with pseudocholinesterase deficiency. This helps reduce risks and ensures a safe delivery. Anesthesiologists and obstetricians should work together to create a plan that fits the patients needs and medical history. […] By making lifestyle changes and teaching family, those with pseudocholinesterase deficiency can manage their health better. Remember, knowledge is power when it comes to managing rare genetic disorders like pseudocholinesterase deficiency.

• #46 What Is Pseudocholinesterase Deficiency?

  https://www.icliniq.com/articles/genetic-disorders/pseudocholinesterase-deficiency

  Pseudocholinesterase deficiency, also known as butyrylcholinesterase deficiency, is an inherited or acquired condition in which the metabolism of certain choline ester drugs such as Succinylcholine, Mivacurium, and ester-linked local anesthetics is altered. […] People with a deficiency of pseudocholinesterase enzymes suffer from prolonged paralysis and apnea after administering drugs like Succinylcholine or Mivacurium. Therefore, these drugs should not be administered to patients having pseudocholinesterase deficiency. […] Pseudocholinesterase deficiency, whether inherited or acquired, should be considered by providers that administer Succinylcholine, including anesthesia, intensive care unit (ICU), emergency department, and perioperative personnel, including the nurses to the patients. Special screening should be done for pregnant women who have either genetic or acquired variants of the condition.

• #47

  https://journals.lww.com/jica/fulltext/2022/01020/revisiting_pseudocholinesterase_deficiency__the.1.aspx

  This issue describes an interesting case of an unusual presentation of pseudocholinesterase (PChE) deficiency in a parturient undergoing emergent cesarean section by Upadaya and Garg. […] It is thus important to revisit PChE deficiency, and start a conversation on this life-threatening but relatively easy-to-manage complication following succinylcholine administration. […] Although PChE deficiency is a rare disorder, it is a serious condition since it is difficult to diagnose clinically preoperatively and can be potentially fatal. However, when diagnosed, it is treatable with ventilatory support till spontaneous recovery. […] A thorough preoperative evaluation can guide the anesthesiologist to the possibility of PChE deficiency. […] It is, therefore, prudent that a detailed preoperative evaluation for any suggestive history or acquired causes of PChE deficiency should be done. Keep a high index of suspicion in the event of delayed or inadequate recovery from neuromuscular block. Plasma enzyme assay will help confirm the diagnosis. […] Patients diagnosed with PChE deficiency are expected to make a full recovery after administration of succinylcholine or mivacurium provided adequate mechanical ventilation and vigilant monitoring is provided to ensure the spontaneous return of motor function.

• #48 Pseudocholinesterase Deficiency | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27928

  Pseudocholinesterase deficiency can be acquired and/or be inherited. […] Individuals with pseudocholinesterase deficiency are often only diagnosed after experiencing prolonged neuromuscular paralysis following standard doses of succinylcholine and mivacurium. The mainstay of treatment involves respiratory support with mechanical ventilation until the spontaneous resolution of neuromuscular blockade. […] Management for those previously diagnosed with pseudocholinesterase deficiency includes the avoidance of depolarizing the neuromuscular blocker succinylcholine and the non-depolarizing muscular blocker mivacurium. Other nondepolarizing neuromuscular blockers such as atracurium, rocuronium, and vecuronium safe for use in future anesthetics. […] Individuals diagnosed with pseudocholinesterase deficiency should inform their doctor and anesthesia provider of their condition before any surgery. The patient’s medical record should be updated to reflect the diagnosis of pseudocholinesterase deficiency. Future anesthetics should avoid administration of succinylcholine and mivacurium to avoid prolonged neuromuscular blockade and possibly respiratory failure. […] Pseudocholinesterase deficiency is best addressed via an interprofessional healthcare team approach, with physicians, specialists, specialty trained nursing staff, and pharmacists, working and communicating to achieve the best possible patient outcomes.

• #49 Acquired pseudocholinesterase deficiency after high-dose cyclophosphamide | Bone Marrow Transplantation

  https://www.nature.com/articles/1702097

  Succinylcholine, a depolarizing neuromuscular blocking agent used in anesthesia is hydrolyzed in the plasma by the enzyme pseudocholinesterase (PSC). […] Conditions associated with reduced PSC activity lead to sustained action of succinylcholine and result in prolonged apnea. […] This case highlights the potential risk of drug-induced PSC deficiency and cautions the use of depolarizing muscular relaxants soon after high-dose cyclophosphamide.

• #50 Mayo Clinic Health Library – Pseudocholinesterase deficiency | Swiss Medical Network

  https://www.swissmedical.net/de/healtcare-library/con-20200770

  This causes sensitivity to certain muscle relaxants used during anesthesia. Muscles may stay relaxed for too long, interfering with movement and breathing. […] Pseudocholinesterase deficiency can be caused by a gene change (mutation) that is inherited. This condition can also be caused by illness, injury or certain medications. […] There is no cure for pseudocholinesterase deficiency. But if you’re diagnosed with the disorder, your health care provider can use other types of muscle relaxants that won’t cause muscle paralysis that lasts longer than expected. […] If you have pseudocholinesterase deficiency, the health care provider who gives you anesthesia (anesthesiologist) can avoid succinylcholine that may trigger prolonged muscle relaxation. The anesthesiologist can choose other muscle relaxants instead.

• #51

  https://cacgas.com/forms

  1) Add „Pseudocholinesterase deficiency” to the „Allergies” of the patient. This will ensure it follows patient throughout hospitalization. It will also be added to their wrist band for this, and future admissions. […] 2) Launch the „Psudocholinesterase deficiency” order set: This will instruct nursing to give a copy of the” „PROLONGED NMB letter” to the patient (family) on discharge, and also add a copy of the letter to the chart. […] 3) Complete and print the PROLONGED NMB LETTER. […] At surgery Centers, please complete the PROLONGED NMB LETTER, and give one copy to patient, one copy for chart.

• #52 Pseudocholinesterase Deficiency | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27928

  Pseudocholinesterase deficiency can be acquired and/or be inherited. […] Individuals with pseudocholinesterase deficiency are often only diagnosed after experiencing prolonged neuromuscular paralysis following standard doses of succinylcholine and mivacurium. The mainstay of treatment involves respiratory support with mechanical ventilation until the spontaneous resolution of neuromuscular blockade. […] Management for those previously diagnosed with pseudocholinesterase deficiency includes the avoidance of depolarizing the neuromuscular blocker succinylcholine and the non-depolarizing muscular blocker mivacurium. Other nondepolarizing neuromuscular blockers such as atracurium, rocuronium, and vecuronium safe for use in future anesthetics. […] Individuals diagnosed with pseudocholinesterase deficiency should inform their doctor and anesthesia provider of their condition before any surgery. The patient’s medical record should be updated to reflect the diagnosis of pseudocholinesterase deficiency. Future anesthetics should avoid administration of succinylcholine and mivacurium to avoid prolonged neuromuscular blockade and possibly respiratory failure. […] Pseudocholinesterase deficiency is best addressed via an interprofessional healthcare team approach, with physicians, specialists, specialty trained nursing staff, and pharmacists, working and communicating to achieve the best possible patient outcomes.

• #53 Health Information Library | Rumah Sakit Pusat Pertamina

  https://rspp.co.id/dcontent.html?id=CON-20200770&n=Pseudocholinesterase%20deficiency

  If needed, a machine that takes over the work of breathing (mechanical ventilation support) and sedation are provided while you recover and start breathing on your own. This may take several hours. […] If you’ve been diagnosed with pseudocholinesterase deficiency, wear a medical alert bracelet or necklace and carry a wallet card. This lets health care professionals know of your risk, especially in an emergency.

• #54 Pseudocholinesterase deficiency

  https://www.mymlc.com/health-information/diseases-and-conditions/p/pseudocholinesterase-deficiency/

  Pseudocholinesterase deficiency is a rare condition that makes you sensitive to certain muscle relaxants used during anesthesia. […] There is no cure for pseudocholinesterase deficiency. But if you’re diagnosed with the condition, your doctor can use other types of muscle relaxants that won’t cause prolonged muscle relaxation. […] If you have pseudocholinesterase deficiency, your anesthesiologist can avoid giving you drugs that may trigger prolonged muscle relaxation and choose other muscle relaxants instead. […] If you have the condition and you receive muscle relaxants that prolong your anesthesia recovery, you’ll likely need medical assistance. If needed, mechanical ventilation support and sedation are provided while you recover and start breathing on your own. […] If you’ve been diagnosed with pseudocholinesterase deficiency, wear a medical alert bracelet or necklace. This lets health care professionals know of your risk, especially in an emergency.

• #55 Residual Muscle Weakness after Succinylcholine Infusion: Clinical Presentation, Diagnosis and Treatment

  https://austinpublishinggroup.com/anesthesia-analgesia/fulltext/ajaa-v2-id1022.php

  Pseudocholinesterase deficiency is synthesized by the liver and exists in plasma. It breaks down Succinylcholine to inactive metabolites. […] The lab results of the 2nd patient did show decreased pseudocholinesterase level (though dubicaine number is unavailable), which indicated decreased enzyme quantity. […] The presence of chronic malignancy increases the likelihood of pseudocholinesterase abnormality, including both quality and quantity, not to mention the possibility of genetic variant of pseudocholinesterase. […] The detection of decreased pseudocholinesterase level may warrant further lab test such as dubicaine number or genetic test for pseudocholinesterase. […] It is prudent to apply neuromuscular monitoring (such as acceleromyography with train-of-four nerve stimulation) during succinylcholine infusion even when the surgery is considered a short procedure.

• #56 2025 Critical Care Congress

  https://congress2025.eventscribe.net/ajaxcalls/PosterInfo.asp?PosterID=718320

  PChE deficiency is rare and results in prolonged paralysis and apnea when NMBAs are administered. […] He was kept intubated, sedated, and transferred to the ICU. […] The diagnosis is confirmed by measuring the plasma PChE activity assay. Normal levels range from 4,000 13,500 U/L while reduced levels indicate deficiency. […] Management includes supportive care and mechanical ventilation. The prognosis is excellent with early detection and recovery is spontaneous. Thus, early recognition is imperative for prevention of complications during anesthesia in affected or high risk individuals.

• #57

  https://arsiv.dusunenadamdergisi.org/ing/fArticledetails4370.html?MkID=1286

  Pseudocholinesterase (PCE) deficiency is an inherited condition in which recovery from anesthetic agents like succinylcholine and mivacurium is slow and complicated by prolonged paralysis of respiratory muscles in susceptible patients. […] Since the measurement of PCE levels of all patients eligible for ECT is part of our pre-ECT assessment procedure, we could detect the deficiency before the ECT procedure. […] We suggest further investigation of this topic because screening for PCE levels in pre-ECT assessment may reduce complications of modified ECT with anesthesia. […] Detection of patients’ serum pseudocholinesterase levels is part of our routine preoperative laboratory workup. […] The PCE level of the patient in the case outlined above was the lowest of the values we have ever detected in our ECT center, and as far as we know it was the lowest value reported in the ECT literature.

• #58 Pseudocholinesterase Deficiency – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK541032/

  Pseudocholinesterase deficiency, also known as butyrylcholinesterase deficiency, refers to a rare acquired or inherited defect in the pseudocholinesterase enzyme produced by the liver. This activity reviews the evaluation and management of pseudocholinesterase deficiency, and highlights the role of the interprofessional team in managing patients with this condition. […] Explain the importance of improving care coordination amongst the interprofessional team to enhance the delivery of care for patients with pseudocholinesterase deficiency. […] The mainstay of treatment involves respiratory support with mechanical ventilation until the spontaneous resolution of neuromuscular blockade. […] Management for those previously diagnosed with pseudocholinesterase deficiency includes the avoidance of depolarizing the neuromuscular blocker succinylcholine and the non-depolarizing muscular blocker mivacurium. […] Pseudocholinesterase deficiency is best addressed via an interprofessional healthcare team approach, with physicians, specialists, specialty trained nursing staff, and pharmacists, working and communicating to achieve the best possible patient outcomes.

• #59 Pseudocholinesterase Deficiency | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27928

  Pseudocholinesterase deficiency can be acquired and/or be inherited. […] Individuals with pseudocholinesterase deficiency are often only diagnosed after experiencing prolonged neuromuscular paralysis following standard doses of succinylcholine and mivacurium. The mainstay of treatment involves respiratory support with mechanical ventilation until the spontaneous resolution of neuromuscular blockade. […] Management for those previously diagnosed with pseudocholinesterase deficiency includes the avoidance of depolarizing the neuromuscular blocker succinylcholine and the non-depolarizing muscular blocker mivacurium. Other nondepolarizing neuromuscular blockers such as atracurium, rocuronium, and vecuronium safe for use in future anesthetics. […] Individuals diagnosed with pseudocholinesterase deficiency should inform their doctor and anesthesia provider of their condition before any surgery. The patient’s medical record should be updated to reflect the diagnosis of pseudocholinesterase deficiency. Future anesthetics should avoid administration of succinylcholine and mivacurium to avoid prolonged neuromuscular blockade and possibly respiratory failure. […] Pseudocholinesterase deficiency is best addressed via an interprofessional healthcare team approach, with physicians, specialists, specialty trained nursing staff, and pharmacists, working and communicating to achieve the best possible patient outcomes.

• #60 Pseudocholinesterase Deficiency: A Case Report and Literature Review

  https://file.scirp.org/Html/21-1920056_22247.htm

  Pseudocholinesterase deficiency is a rare cause of prolonged paralysis, regarding which any clinician utilizing paralytics should be educated. […] The management of patients with prolonged paralysis due to PChE deficiency is mainly conservative. Patients are maintained with mechanical ventilation under sedation while the effect of the paralytic is cleared. […] If PChE deficiency is suspected, the patient and family should be counseled with recommendation of further diagnostic tests and a Medic Alert bracelet should be issued.

• #61 Hereditary pseudocholinesterase deficiency in a 4-year-old girl: a case report | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-025-05183-5

  A timely working diagnosis of pseudocholinesterase deficiency is crucial, because it can help avoid unnecessary exposure to other medication (for example, naloxone, flumazenil, and physostigmine), and because the prognosis of pseudocholinesterase deficiency is excellent once supportive management has been initiated. Treatment of perioperative complications usually involves continued mechanical ventilation until the culprit agent has been metabolized and any residual paralysis has subsided. […] In summary, pseudocholinesterase deficiency is a rare disorder that commonly presents as prolonged apnea and paralysis following general anesthesia after induction with succinylcholine or mivacurium. A causal treatment does not currently exist. However, the disorder typically has a benign course, and an excellent prognosis, if supportive management, including prolonged post-operative ventilatory support, can be provided.

• #62

  https://journals.lww.com/jica/fulltext/2022/01020/revisiting_pseudocholinesterase_deficiency__the.1.aspx

  This issue describes an interesting case of an unusual presentation of pseudocholinesterase (PChE) deficiency in a parturient undergoing emergent cesarean section by Upadaya and Garg. […] It is thus important to revisit PChE deficiency, and start a conversation on this life-threatening but relatively easy-to-manage complication following succinylcholine administration. […] Although PChE deficiency is a rare disorder, it is a serious condition since it is difficult to diagnose clinically preoperatively and can be potentially fatal. However, when diagnosed, it is treatable with ventilatory support till spontaneous recovery. […] A thorough preoperative evaluation can guide the anesthesiologist to the possibility of PChE deficiency. […] It is, therefore, prudent that a detailed preoperative evaluation for any suggestive history or acquired causes of PChE deficiency should be done. Keep a high index of suspicion in the event of delayed or inadequate recovery from neuromuscular block. Plasma enzyme assay will help confirm the diagnosis. […] Patients diagnosed with PChE deficiency are expected to make a full recovery after administration of succinylcholine or mivacurium provided adequate mechanical ventilation and vigilant monitoring is provided to ensure the spontaneous return of motor function.

• #63 Pseudocholinesterase Deficiency: Symptoms & Treatment

  https://www.medicoverhospitals.in/diseases/pseudocholinesterase-deficiency/

  In cases where standard anesthetics are used, close monitoring in a post-operative setting is necessary. Mechanical ventilation and supportive care may be required until muscle function and breathing return to normal. […] Treatment focuses on careful management during anesthesia and may include using alternative medications that do not rely on cholinesterase for metabolism.

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