Materiały źródłowe

• #1 Pseudocholinesterase Deficiency Treatment & Management: Medical Care

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

  Pseudocholinesterase deficiency is a clinically silent condition seen in individuals who are not exposed to exogenous sources of choline esters. […] Prophylactic transfusion of fresh frozen plasma can augment the patient’s endogenous plasma pseudocholinesterase activity. This practice is not recommended because of the risk of iatrogenic viral infectious complications. However, perioperative transfusion of fresh frozen plasma administered to correct a coagulopathy may mask an underlying pseudocholinesterase deficiency. […] 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.

• #2 Pseudocholinesterase Deficiency – StatPearls – NCBI Bookshelf

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

  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. […] Family members of patients with pseudocholinesterase deficiency are encouraged to undergo laboratory testing due to a strong genetic component associated with inheriting an abnormal variant of the pseudocholinesterase gene.

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

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

  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. Family members of patients with pseudocholinesterase deficiency are encouraged to undergo laboratory testing due to a strong genetic component associated with inheriting an abnormal variant of the pseudocholinesterase gene. […] 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.

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

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

  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. Family members of patients with pseudocholinesterase deficiency are encouraged to undergo laboratory testing due to a strong genetic component associated with inheriting an abnormal variant of the pseudocholinesterase gene. […] 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.

• #5 Health Information Library | Rumah Sakit Pusat Pertamina

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

  If you have a family history of pseudocholinesterase deficiency or have a family member who had any problem with anesthesia, tell your health care provider before getting a medical procedure that requires anesthesia. […] If you have a family history of pseudocholinesterase deficiency, you can prevent problems during anesthesia by having testing before the procedure. […] Evaluating your risk of pseudocholinesterase deficiency allows your health care provider to avoid certain muscle relaxants, if needed.

• #6 Pseudocholinesterase deficiency

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

  If you have a family history of pseudocholinesterase deficiency or have a family member who had any problem with anesthesia, tell your doctor before getting a medical procedure that requires general anesthesia. […] Evaluating your risk of pseudocholinesterase deficiency allows your anesthesiologist to avoid certain drugs, if needed.

• #7 Health Information Library | Rumah Sakit Pusat Pertamina

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

  If you have a family history of pseudocholinesterase deficiency or have a family member who had any problem with anesthesia, tell your health care provider before getting a medical procedure that requires anesthesia. […] If you have a family history of pseudocholinesterase deficiency, you can prevent problems during anesthesia by having testing before the procedure. […] Evaluating your risk of pseudocholinesterase deficiency allows your health care provider to avoid certain muscle relaxants, if needed.

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

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

  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’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.

• #9 Pseudocholinesterase Deficiency: Symptoms & Treatment

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

  You cant 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. […] If you have the gene mutation, your provider will avoid choline esters and choose another type of anesthetic instead. Rocuronium is one of the most used anesthetic medications for people with pseudocholinesterase deficiency. […] You may be able to reduce your risk for acquired pseudocholinesterase deficiency by treating underlying health conditions like malnutrition or chronic kidney disease (CKD). You can also ask your healthcare provider about switching medications if youre taking something that lowers your production of pseudocholinesterase enzyme. […] If you have a pseudocholinesterase deficiency diagnosis, you should avoid certain anesthetic medications, including: […] Consider wearing a medical ID bracelet that informs healthcare providers about your condition. This can be helpful if you ever need emergency surgery.

• #10 Pseudocholinesterase deficiency – Wikipedia

  https://en.wikipedia.org/wiki/Pseudocholinesterase_deficiency

  Patients with known pseudocholinesterase deficiency may wear a medic-alert bracelet that will notify healthcare workers of increased risk from administration of succinylcholine, and use a non-depolarising neuromuscular-blocking drug for general anesthesia, such as rocuronium. […] If this condition is recognized by the anesthesiologist early, then there is rarely a problem, as the patient can be kept intubated and sedated until the muscle relaxation resolves.

• #11 Pseudocholinesterase Deficiency | Apollo Hospitals

  https://www.apollohospitals.com/diseases-and-conditions/pseudocholinesterase-deficiency/

  Pseudocholinesterase deficiency results in the slower metabolism of medications used in anesthesia like succinylcholine, mivacurium, procaine, etc. […] A patients sensitivity towards succinylcholine makes him or her susceptible to harm and puts him or her at a health risk from anaesthesia. […] If you suffer from PCE deficiency, your first and foremost step should be informing your doctor or physician when they prescribe medications for you. […] Wearing a medical alert bracelet/necklace that indicates PCE deficiency will enable healthcare workers to realize your condition in the event of an accident/injury/surgery. […] If your surgeon/doctor is unaware of your pseudocholinesterase deficiency, then you may suffer from loss of breathing.

• #12 Pseudocholinesterase Deficiency | Apollo Hospitals

  https://www.apollohospitals.com/diseases-and-conditions/pseudocholinesterase-deficiency

  Pseudocholinesterase deficiency results in the slower metabolism of medications used in anesthesia like succinylcholine, mivacurium, procaine, etc. […] A patient’s sensitivity towards succinylcholine makes him or her susceptible to harm and puts him or her at a health risk from anesthesia. […] If you suffer from PCE deficiency, your first and foremost step should be informing your doctor or physician when they prescribe medications for you. […] Wearing a medical alert bracelet/necklace that indicates PCE deficiency will enable healthcare workers to realize your condition in the event of an accident/injury/surgery. […] If your surgeon/doctor is unaware of your pseudocholinesterase deficiency, then you may suffer from loss of breathing.

• #13

  https://link.springer.com/article/10.1007/BF03002224

  Pseudocholinesterase is essential for the rapid breakdown of succinylcholine. If pseudocholinesterase is quantitatively or qualitatively deficient, prolonged apnoea may result after administration of succinylcholine. […] Knowledge of a low pseudocholinesterase level will certainly be of interest. […] If it is of genetic origin, it is a permanent defect and such persons should receive a warning card to alert physicians regarding this biochemical abnormality. […] Tous les individus chez qui on dpiste un trouble des pseudocholinesterases devraient porter une carte ou un disque davertissement.

• #14 Health Information Library | Rumah Sakit Pusat Pertamina

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

  If you have a family history of pseudocholinesterase deficiency or have a family member who had any problem with anesthesia, tell your health care provider before getting a medical procedure that requires anesthesia. […] If you have a family history of pseudocholinesterase deficiency, you can prevent problems during anesthesia by having testing before the procedure. […] Evaluating your risk of pseudocholinesterase deficiency allows your health care provider to avoid certain muscle relaxants, if needed.

• #15 Cholinesterase Tests – Testing.com

  https://www.testing.com/tests/cholinesterase-test/

  Sometimes to identify individuals with inherited pseudocholinesterase deficiency before they are given anesthesia with the muscle relaxant succinylcholine or to help determine the cause of prolonged apnea after surgical anesthesia. […] Pre-operative screening for pseudocholinesterase activity is advised if a person or a close relative has experienced prolonged paralysis and apnea after the use of succinylcholine for anesthesia during an operation. […] Pseudocholinesterase testing can be performed prior to surgery on those with a family history of prolonged apnea after use of succinylcholine to determine if they are at risk of complications related to this drug.

• #16 Pseudocholinesterase Deficiency Treatment & Management: Medical Care

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

  Pseudocholinesterase deficiency is a clinically silent condition seen in individuals who are not exposed to exogenous sources of choline esters. […] Prophylactic transfusion of fresh frozen plasma can augment the patient’s endogenous plasma pseudocholinesterase activity. This practice is not recommended because of the risk of iatrogenic viral infectious complications. However, perioperative transfusion of fresh frozen plasma administered to correct a coagulopathy may mask an underlying pseudocholinesterase deficiency. […] 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.

• #17 Pseudocholinesterase Deficiency Treatment & Management: Medical Care

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

  Pseudocholinesterase deficiency is a clinically silent condition seen in individuals who are not exposed to exogenous sources of choline esters. […] Prophylactic transfusion of fresh frozen plasma can augment the patient’s endogenous plasma pseudocholinesterase activity. This practice is not recommended because of the risk of iatrogenic viral infectious complications. However, perioperative transfusion of fresh frozen plasma administered to correct a coagulopathy may mask an underlying pseudocholinesterase deficiency. […] 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.

• #18 Pseudocholinesterase Deficiency and Patient Perspectives

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

  Fortunately, there are other paralytic alternatives that have different metabolism mechanisms, such as rocuronium, vecuronium, atracurium and cisatracurium that will not significantly prolong neuromuscular blockade. […] Pseudocholinesterase deficiency is inherited in an autosomal recessive manner; however, given the large genetic component, it is recommended that immediate family members get tested. Testing can be done with a dibucaine number as mentioned above, or providers can send for a plasma pseudocholinesterase level.

• #19 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. […] The condition is inherited in an autosomal recessive pattern or may be acquired due to liver disease, renal failure, malnutrition, and pregnancy. […] It can be discovered when respiratory paralysis persists after administration of NMBAs. […] The diagnosis is confirmed by measuring the plasma PChE activity assay. […] Management includes supportive care and mechanical ventilation. […] Thus, early recognition is imperative for prevention of complications during anesthesia in affected or high risk individuals.

• #20 Pseudocholinesterase Deficiency – StatPearls – NCBI Bookshelf

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

  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. […] Family members of patients with pseudocholinesterase deficiency are encouraged to undergo laboratory testing due to a strong genetic component associated with inheriting an abnormal variant of the pseudocholinesterase gene.

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

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

  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. Family members of patients with pseudocholinesterase deficiency are encouraged to undergo laboratory testing due to a strong genetic component associated with inheriting an abnormal variant of the pseudocholinesterase gene. […] 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.

• #22 Delayed recovery from paralysis by succinylcholine in patient with preoperatively unrecognized and inherited pseudocholinesterase deficiency

  https://ekja.org/journal/view.php?number=7771

  Pseudocholinesterase deficiency, arising from inherited, acquired, and iatrogenic causes, produces prolonged neuromuscular blockade after succinylcholine administration used for endotracheal intubation. […] Because prolonged apnea due to pseudocholinesterase deficiency is triggered after mivacurium or succinylcholine administration for muscle relaxation, pseudocholinesterase deficiency is clinically asymptomatic in patients without any previous history of receiving succinylcholine or mivacurium. […] Therefore, it was important to determine the pseudocholinesterase levels in the patient and all family members. […] Taking this case into consideration, after succinylcholine administration, anesthesiologists should apply a peripheral nerve stimulator to assess the extent of muscle relaxation reversal or carefully observe the return of spontaneous respiration, and then determine whether to administer an additional non-depolarizing muscle relaxant.

• #23 Delayed recovery from paralysis by succinylcholine in patient with preoperatively unrecognized and inherited pseudocholinesterase deficiency

  https://ekja.org/journal/view.php?number=7771

  In conclusion, if pseudocholinesterase deficiency is suspected of causing unexpected prolonged apnea after succinylcholine administration, the following measures are very important: 1) controlled mechanical ventilation with sufficient sedation until succinylcholine is completely metabolized; 2) determination of pseudocholinesterase levels in the patient and all family members; 3) avoidance of further exposure to succinylcholine, mivacurium, and aminoester local anesthetics; and 4) notification given to medical doctors on any subsequent hospital visit that a patient has pseudocholinesterase deficiency.

• #24 Pseudocholinesterase Deficiency: Symptoms & Treatment

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

  While genetic causes cannot be prevented, awareness and proactive management can significantly reduce the risks associated with pseudocholinesterase deficiency. […] Family members of affected individuals should consider genetic counseling and testing to determine their risk of carrying or passing on the defective gene. […] For those with acquired pseudocholinesterase deficiency, avoiding exposure to certain chemicals and managing underlying health conditions like liver disease can help maintain enzyme activity levels.

• #25 Pseudocholinesterase Deficiency and Patient Perspectives

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

  Fortunately, there are other paralytic alternatives that have different metabolism mechanisms, such as rocuronium, vecuronium, atracurium and cisatracurium that will not significantly prolong neuromuscular blockade. […] Pseudocholinesterase deficiency is inherited in an autosomal recessive manner; however, given the large genetic component, it is recommended that immediate family members get tested. Testing can be done with a dibucaine number as mentioned above, or providers can send for a plasma pseudocholinesterase level.

• #26 Pseudocholinesterase Deficiency – StatPearls – NCBI Bookshelf

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

  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. […] Family members of patients with pseudocholinesterase deficiency are encouraged to undergo laboratory testing due to a strong genetic component associated with inheriting an abnormal variant of the pseudocholinesterase gene.

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

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

  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. Family members of patients with pseudocholinesterase deficiency are encouraged to undergo laboratory testing due to a strong genetic component associated with inheriting an abnormal variant of the pseudocholinesterase gene. […] 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.

• #28 Pseudocholinesterase Deficiency: Symptoms & Treatment

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

  You cant 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. […] If you have the gene mutation, your provider will avoid choline esters and choose another type of anesthetic instead. Rocuronium is one of the most used anesthetic medications for people with pseudocholinesterase deficiency. […] You may be able to reduce your risk for acquired pseudocholinesterase deficiency by treating underlying health conditions like malnutrition or chronic kidney disease (CKD). You can also ask your healthcare provider about switching medications if youre taking something that lowers your production of pseudocholinesterase enzyme. […] If you have a pseudocholinesterase deficiency diagnosis, you should avoid certain anesthetic medications, including: […] Consider wearing a medical ID bracelet that informs healthcare providers about your condition. This can be helpful if you ever need emergency surgery.

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

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

  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. Family members of patients with pseudocholinesterase deficiency are encouraged to undergo laboratory testing due to a strong genetic component associated with inheriting an abnormal variant of the pseudocholinesterase gene. […] 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.

• #30 Pseudocholinesterase Deficiency and Patient Perspectives

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

  Pseudocholinesterase deficiency is usually diagnosed retrospectively after a patient has received general anesthesia with succinylcholine or mivacurium used for endotracheal intubation. […] To prevent future incidence of prolonged paralysis, patients with pseudocholinesterase deficiency should avoid succinylcholine and mivacurium. This involves properly educating patients on this new diagnosis. Another failsafe method to prevent reoccurrence is to list mivacurium and succinylcholine as sources of patient allergies or adverse reactions. Reoccurrence can also be deterred by a thoroughly conducted preoperative assessment by the anesthesia provider. Questions aimed at previous surgeries and issues with anesthesia in the past can elicit a history of pseudocholinesterase deficiency from patients.

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

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

  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. Family members of patients with pseudocholinesterase deficiency are encouraged to undergo laboratory testing due to a strong genetic component associated with inheriting an abnormal variant of the pseudocholinesterase gene. […] 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.

• #32 Pseudocholinesterase Deficiency and Patient Perspectives

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

  Pseudocholinesterase deficiency is usually diagnosed retrospectively after a patient has received general anesthesia with succinylcholine or mivacurium used for endotracheal intubation. […] To prevent future incidence of prolonged paralysis, patients with pseudocholinesterase deficiency should avoid succinylcholine and mivacurium. This involves properly educating patients on this new diagnosis. Another failsafe method to prevent reoccurrence is to list mivacurium and succinylcholine as sources of patient allergies or adverse reactions. Reoccurrence can also be deterred by a thoroughly conducted preoperative assessment by the anesthesia provider. Questions aimed at previous surgeries and issues with anesthesia in the past can elicit a history of pseudocholinesterase deficiency from patients.

• #33 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. […] Therefore, these drugs should not be administered to patients having pseudocholinesterase deficiency. […] The enzymatic activity is said to be reduced by 24 % during pregnancy, 25 % on day one postpartum, and 33 % on day three postpartum, respectively. Therefore, selecting an appropriate anesthetic plan for the pregnant woman is important because normal reductions in the plasma enzyme levels combined with a genetic variant could prove fatal if exposed to Succinylcholine or a local ester anesthetic like Chloroprocaine. […] 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.

• #34 Pseudocholinesterase Deficiency | Apollo Hospitals

  https://www.apollohospitals.com/diseases-and-conditions/pseudocholinesterase-deficiency/

  Pseudocholinesterase deficiency results in the slower metabolism of medications used in anesthesia like succinylcholine, mivacurium, procaine, etc. […] A patients sensitivity towards succinylcholine makes him or her susceptible to harm and puts him or her at a health risk from anaesthesia. […] If you suffer from PCE deficiency, your first and foremost step should be informing your doctor or physician when they prescribe medications for you. […] Wearing a medical alert bracelet/necklace that indicates PCE deficiency will enable healthcare workers to realize your condition in the event of an accident/injury/surgery. […] If your surgeon/doctor is unaware of your pseudocholinesterase deficiency, then you may suffer from loss of breathing.

• #35 Pseudocholinesterase Deficiency: Anesthesia Considerations – Radius Anesthesia of Michigan

  https://radiusmichigan.com/pseudocholinesterase-deficiency-anesthesia/

  Pseudocholinesterase deficiency is characterized by the reduced ability to metabolize and thereby terminate the effects of certain muscle relaxants, resulting in prolonged muscular paralysis from standard doses. […] Pseudocholinesterase individuals in need of anesthesia can avoid paralysis by undergoing treatment with different neuromuscular blockers, such as atracurium and rocuronium. […] Considering the various genetic variants, medical conditions, and yet unknown molecular mechanisms that are linked to pseudocholinesterase deficiency and thereby bring about prolonged anesthesia-induced paralysis, anesthesia providers should take great care when prescribing choline ester anesthetics. […] Pseudocholinesterase deficiency is rare, but anesthesia providers should be equipped to detect it in advance and prevent its potentially harmful consequences.

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

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

  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. Family members of patients with pseudocholinesterase deficiency are encouraged to undergo laboratory testing due to a strong genetic component associated with inheriting an abnormal variant of the pseudocholinesterase gene. […] 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.

• #37 Pseudocholinesterase Deficiency and Patient Perspectives

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

  Fortunately, there are other paralytic alternatives that have different metabolism mechanisms, such as rocuronium, vecuronium, atracurium and cisatracurium that will not significantly prolong neuromuscular blockade. […] Pseudocholinesterase deficiency is inherited in an autosomal recessive manner; however, given the large genetic component, it is recommended that immediate family members get tested. Testing can be done with a dibucaine number as mentioned above, or providers can send for a plasma pseudocholinesterase level.

• #38 Pseudocholinesterase Deficiency: Symptoms & Treatment

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

  You cant 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. […] If you have the gene mutation, your provider will avoid choline esters and choose another type of anesthetic instead. Rocuronium is one of the most used anesthetic medications for people with pseudocholinesterase deficiency. […] You may be able to reduce your risk for acquired pseudocholinesterase deficiency by treating underlying health conditions like malnutrition or chronic kidney disease (CKD). You can also ask your healthcare provider about switching medications if youre taking something that lowers your production of pseudocholinesterase enzyme. […] If you have a pseudocholinesterase deficiency diagnosis, you should avoid certain anesthetic medications, including: […] Consider wearing a medical ID bracelet that informs healthcare providers about your condition. This can be helpful if you ever need emergency surgery.

• #39 Pseudocholinesterase deficiency – Wikipedia

  https://en.wikipedia.org/wiki/Pseudocholinesterase_deficiency

  Patients with known pseudocholinesterase deficiency may wear a medic-alert bracelet that will notify healthcare workers of increased risk from administration of succinylcholine, and use a non-depolarising neuromuscular-blocking drug for general anesthesia, such as rocuronium. […] If this condition is recognized by the anesthesiologist early, then there is rarely a problem, as the patient can be kept intubated and sedated until the muscle relaxation resolves.

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

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

  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. Family members of patients with pseudocholinesterase deficiency are encouraged to undergo laboratory testing due to a strong genetic component associated with inheriting an abnormal variant of the pseudocholinesterase gene. […] 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.

• #41 Pseudocholinesterase Deficiency and Patient Perspectives

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

  Fortunately, there are other paralytic alternatives that have different metabolism mechanisms, such as rocuronium, vecuronium, atracurium and cisatracurium that will not significantly prolong neuromuscular blockade. […] Pseudocholinesterase deficiency is inherited in an autosomal recessive manner; however, given the large genetic component, it is recommended that immediate family members get tested. Testing can be done with a dibucaine number as mentioned above, or providers can send for a plasma pseudocholinesterase level.

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

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

  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. Family members of patients with pseudocholinesterase deficiency are encouraged to undergo laboratory testing due to a strong genetic component associated with inheriting an abnormal variant of the pseudocholinesterase gene. […] 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.

• #43 Pseudocholinesterase Deficiency and Patient Perspectives

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

  Fortunately, there are other paralytic alternatives that have different metabolism mechanisms, such as rocuronium, vecuronium, atracurium and cisatracurium that will not significantly prolong neuromuscular blockade. […] Pseudocholinesterase deficiency is inherited in an autosomal recessive manner; however, given the large genetic component, it is recommended that immediate family members get tested. Testing can be done with a dibucaine number as mentioned above, or providers can send for a plasma pseudocholinesterase level.

• #44 Pseudocholinesterase Deficiency and Patient Perspectives

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

  Fortunately, there are other paralytic alternatives that have different metabolism mechanisms, such as rocuronium, vecuronium, atracurium and cisatracurium that will not significantly prolong neuromuscular blockade. […] Pseudocholinesterase deficiency is inherited in an autosomal recessive manner; however, given the large genetic component, it is recommended that immediate family members get tested. Testing can be done with a dibucaine number as mentioned above, or providers can send for a plasma pseudocholinesterase level.

• #45 Comparison between succinylcholine and rocuronium as neuromuscular blocking agents for electroconvulsive therapy in a patient with pseudocholinesterase deficiency | JA Clinical Reports | Full Text

  https://jaclinicalreports.springeropen.com/articles/10.1186/s40981-015-0009-2

  ROC administration followed by sugammadex reversal of neuromuscular blockade seems to be better than succinylcholine for ECT, particularly in patients with pseudocholinesterase deficiency. […] The advantages of use of ROC-sugammadex for ECT, including fast recovery from muscle relaxation and fewer side effects, may outweigh the high cost of its usage. The superiority of ROC-sugammadex for ECT is even more obvious in subjects with pseudocholinesterase deficiency, since spontaneous recovery from muscle relaxant effects after SCC is expected to be markedly prolonged in such cases.

• #46 Comparison between succinylcholine and rocuronium as neuromuscular blocking agents for electroconvulsive therapy in a patient with pseudocholinesterase deficiency | JA Clinical Reports | Full Text

  https://jaclinicalreports.springeropen.com/articles/10.1186/s40981-015-0009-2

  ROC administration followed by sugammadex reversal of neuromuscular blockade seems to be better than succinylcholine for ECT, particularly in patients with pseudocholinesterase deficiency. […] The advantages of use of ROC-sugammadex for ECT, including fast recovery from muscle relaxation and fewer side effects, may outweigh the high cost of its usage. The superiority of ROC-sugammadex for ECT is even more obvious in subjects with pseudocholinesterase deficiency, since spontaneous recovery from muscle relaxant effects after SCC is expected to be markedly prolonged in such cases.

• #47 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. […] Therefore, these drugs should not be administered to patients having pseudocholinesterase deficiency. […] The enzymatic activity is said to be reduced by 24 % during pregnancy, 25 % on day one postpartum, and 33 % on day three postpartum, respectively. Therefore, selecting an appropriate anesthetic plan for the pregnant woman is important because normal reductions in the plasma enzyme levels combined with a genetic variant could prove fatal if exposed to Succinylcholine or a local ester anesthetic like Chloroprocaine. […] 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.

• #48 Pseudocholinesterase Deficiency: Symptoms & Treatment

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

  You cant 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. […] If you have the gene mutation, your provider will avoid choline esters and choose another type of anesthetic instead. Rocuronium is one of the most used anesthetic medications for people with pseudocholinesterase deficiency. […] You may be able to reduce your risk for acquired pseudocholinesterase deficiency by treating underlying health conditions like malnutrition or chronic kidney disease (CKD). You can also ask your healthcare provider about switching medications if youre taking something that lowers your production of pseudocholinesterase enzyme. […] If you have a pseudocholinesterase deficiency diagnosis, you should avoid certain anesthetic medications, including: […] Consider wearing a medical ID bracelet that informs healthcare providers about your condition. This can be helpful if you ever need emergency surgery.

• #49 Pseudocholinesterase Deficiency: Symptoms & Treatment

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

  While genetic causes cannot be prevented, awareness and proactive management can significantly reduce the risks associated with pseudocholinesterase deficiency. […] Family members of affected individuals should consider genetic counseling and testing to determine their risk of carrying or passing on the defective gene. […] For those with acquired pseudocholinesterase deficiency, avoiding exposure to certain chemicals and managing underlying health conditions like liver disease can help maintain enzyme activity levels.

• #50

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

  Prevention is the best cure and this old adage could not be truer for a patient with PChE deficiency. A thorough preoperative evaluation can guide the anesthesiologist to the possibility of PChE deficiency. A detailed history should include medical history for acquired causes, any previous anesthesia exposure requiring extended mechanical ventilation due to neuromuscular blockade in the patient as well as any family history of relatives in susceptible populations. […] Preoperative evaluation should include a careful history of drug intake. Recently, Zencirci has reported sertraline-associated acquired PChE deficiency and prolonged muscular paralysis following the administration of mivacurium. […] 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. The patient may be advised to wear a MedicAlert bracelet and the immediate family members should be encouraged to get tested keeping in mind the genetic inheritance of PChE deficiency.

• #51 Pseudocholinesterase Deficiency in an Indian Community | Journal of Pharmacy Practice and Community Medicine

  https://jppcm.org/archives/article/60.html

  Arya Vysya community people of India having deficiency of pseudocholinesterase is the most affected people than any other with homozygous mutation incidence rate of 2-4%. […] It was suggested that the Arya Vysya Community people with a history of pseudocholinesterase deficiency should tell his or her doctor if when they undergo anesthesia for surgery to avoid potentially serious unwanted adverse effects.

• #52 Pseudocholinesterase Deficiency in an Indian Community | Journal of Pharmacy Practice and Community Medicine

  https://jppcm.org/archives/article/60.html

  Arya Vysya community people of India having deficiency of pseudocholinesterase is the most affected people than any other with homozygous mutation incidence rate of 2-4%. […] It was suggested that the Arya Vysya Community people with a history of pseudocholinesterase deficiency should tell his or her doctor if when they undergo anesthesia for surgery to avoid potentially serious unwanted adverse effects.

• #53 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. […] The condition is inherited in an autosomal recessive pattern or may be acquired due to liver disease, renal failure, malnutrition, and pregnancy. […] It can be discovered when respiratory paralysis persists after administration of NMBAs. […] The diagnosis is confirmed by measuring the plasma PChE activity assay. […] Management includes supportive care and mechanical ventilation. […] Thus, early recognition is imperative for prevention of complications during anesthesia in affected or high risk individuals.

• #54 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. […] Diagnostic tests for pseudocholinesterase deficiency are not part of a routine preoperative work-up, and patients are typically asymptomatic in their daily lives. […] 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. […] To ensure a timely diagnosis, pseudocholinesterase deficiency must be included in the differential diagnosis of delayed emergence, and the combination of sustained paralysis despite indicators of increasingly light residual sedation or distress (that is, increasing EEG indices, tachycardia, and hypertension) should immediately raise suspicions of an abnormal response to mivacurium or succinylcholine. […] Once suspected, a clinical diagnosis can be supported using a peripheral nerve stimulator, and confirmed using laboratory tests, while genetic testing can help determine the etiology of disease.

• #55 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. […] Diagnostic tests for pseudocholinesterase deficiency are not part of a routine preoperative work-up, and patients are typically asymptomatic in their daily lives. […] 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. […] To ensure a timely diagnosis, pseudocholinesterase deficiency must be included in the differential diagnosis of delayed emergence, and the combination of sustained paralysis despite indicators of increasingly light residual sedation or distress (that is, increasing EEG indices, tachycardia, and hypertension) should immediately raise suspicions of an abnormal response to mivacurium or succinylcholine. […] Once suspected, a clinical diagnosis can be supported using a peripheral nerve stimulator, and confirmed using laboratory tests, while genetic testing can help determine the etiology of disease.

• #56 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. […] Diagnostic tests for pseudocholinesterase deficiency are not part of a routine preoperative work-up, and patients are typically asymptomatic in their daily lives. […] 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. […] To ensure a timely diagnosis, pseudocholinesterase deficiency must be included in the differential diagnosis of delayed emergence, and the combination of sustained paralysis despite indicators of increasingly light residual sedation or distress (that is, increasing EEG indices, tachycardia, and hypertension) should immediately raise suspicions of an abnormal response to mivacurium or succinylcholine. […] Once suspected, a clinical diagnosis can be supported using a peripheral nerve stimulator, and confirmed using laboratory tests, while genetic testing can help determine the etiology of disease.

• #57 Delayed recovery from paralysis by succinylcholine in patient with preoperatively unrecognized and inherited pseudocholinesterase deficiency

  https://ekja.org/journal/view.php?number=7771

  In conclusion, if pseudocholinesterase deficiency is suspected of causing unexpected prolonged apnea after succinylcholine administration, the following measures are very important: 1) controlled mechanical ventilation with sufficient sedation until succinylcholine is completely metabolized; 2) determination of pseudocholinesterase levels in the patient and all family members; 3) avoidance of further exposure to succinylcholine, mivacurium, and aminoester local anesthetics; and 4) notification given to medical doctors on any subsequent hospital visit that a patient has pseudocholinesterase deficiency.

• #58 Delayed recovery from paralysis by succinylcholine in patient with preoperatively unrecognized and inherited pseudocholinesterase deficiency

  https://ekja.org/journal/view.php?number=7771

  In conclusion, if pseudocholinesterase deficiency is suspected of causing unexpected prolonged apnea after succinylcholine administration, the following measures are very important: 1) controlled mechanical ventilation with sufficient sedation until succinylcholine is completely metabolized; 2) determination of pseudocholinesterase levels in the patient and all family members; 3) avoidance of further exposure to succinylcholine, mivacurium, and aminoester local anesthetics; and 4) notification given to medical doctors on any subsequent hospital visit that a patient has pseudocholinesterase deficiency.

• #59 Delayed recovery from paralysis by succinylcholine in patient with preoperatively unrecognized and inherited pseudocholinesterase deficiency

  https://ekja.org/journal/view.php?number=7771

  In conclusion, if pseudocholinesterase deficiency is suspected of causing unexpected prolonged apnea after succinylcholine administration, the following measures are very important: 1) controlled mechanical ventilation with sufficient sedation until succinylcholine is completely metabolized; 2) determination of pseudocholinesterase levels in the patient and all family members; 3) avoidance of further exposure to succinylcholine, mivacurium, and aminoester local anesthetics; and 4) notification given to medical doctors on any subsequent hospital visit that a patient has pseudocholinesterase deficiency.

• #60 Delayed recovery from paralysis by succinylcholine in patient with preoperatively unrecognized and inherited pseudocholinesterase deficiency

  https://ekja.org/journal/view.php?number=7771

  In conclusion, if pseudocholinesterase deficiency is suspected of causing unexpected prolonged apnea after succinylcholine administration, the following measures are very important: 1) controlled mechanical ventilation with sufficient sedation until succinylcholine is completely metabolized; 2) determination of pseudocholinesterase levels in the patient and all family members; 3) avoidance of further exposure to succinylcholine, mivacurium, and aminoester local anesthetics; and 4) notification given to medical doctors on any subsequent hospital visit that a patient has pseudocholinesterase deficiency.

• #61 Delayed recovery from paralysis by succinylcholine in patient with preoperatively unrecognized and inherited pseudocholinesterase deficiency

  https://ekja.org/journal/view.php?number=7771

  In conclusion, if pseudocholinesterase deficiency is suspected of causing unexpected prolonged apnea after succinylcholine administration, the following measures are very important: 1) controlled mechanical ventilation with sufficient sedation until succinylcholine is completely metabolized; 2) determination of pseudocholinesterase levels in the patient and all family members; 3) avoidance of further exposure to succinylcholine, mivacurium, and aminoester local anesthetics; and 4) notification given to medical doctors on any subsequent hospital visit that a patient has pseudocholinesterase deficiency.

• #62 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. […] Another effective method to prevent its incidence is to list Mivacurium and Succinylcholine drugs as sources of patient allergies. Reoccurrence can also be reduced by a thoroughly conducted preoperative assessment by the anesthesia and healthcare provider. Patients suffering from Pseudocholinesterase deficiency should also be properly educated about the adverse reactions of these drugs.

• #63 Pseudocholinesterase Deficiency Treatment & Management: Medical Care

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

  Pseudocholinesterase deficiency is a clinically silent condition seen in individuals who are not exposed to exogenous sources of choline esters. […] Prophylactic transfusion of fresh frozen plasma can augment the patient’s endogenous plasma pseudocholinesterase activity. This practice is not recommended because of the risk of iatrogenic viral infectious complications. However, perioperative transfusion of fresh frozen plasma administered to correct a coagulopathy may mask an underlying pseudocholinesterase deficiency. […] 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.

• #64 Pseudocholinesterase Deficiency and Patient Perspectives

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

  Pseudocholinesterase deficiency is usually diagnosed retrospectively after a patient has received general anesthesia with succinylcholine or mivacurium used for endotracheal intubation. […] To prevent future incidence of prolonged paralysis, patients with pseudocholinesterase deficiency should avoid succinylcholine and mivacurium. This involves properly educating patients on this new diagnosis. Another failsafe method to prevent reoccurrence is to list mivacurium and succinylcholine as sources of patient allergies or adverse reactions. Reoccurrence can also be deterred by a thoroughly conducted preoperative assessment by the anesthesia provider. Questions aimed at previous surgeries and issues with anesthesia in the past can elicit a history of pseudocholinesterase deficiency from patients.

• #65 Pseudocholinesterase Deficiency | Apollo Hospitals

  https://www.apollohospitals.com/diseases-and-conditions/pseudocholinesterase-deficiency/

  Pseudocholinesterase deficiency results in the slower metabolism of medications used in anesthesia like succinylcholine, mivacurium, procaine, etc. […] A patients sensitivity towards succinylcholine makes him or her susceptible to harm and puts him or her at a health risk from anaesthesia. […] If you suffer from PCE deficiency, your first and foremost step should be informing your doctor or physician when they prescribe medications for you. […] Wearing a medical alert bracelet/necklace that indicates PCE deficiency will enable healthcare workers to realize your condition in the event of an accident/injury/surgery. […] If your surgeon/doctor is unaware of your pseudocholinesterase deficiency, then you may suffer from loss of breathing.

• #66 Pseudocholinesterase Deficiency | Apollo Hospitals

  https://www.apollohospitals.com/diseases-and-conditions/pseudocholinesterase-deficiency/

  Pseudocholinesterase deficiency results in the slower metabolism of medications used in anesthesia like succinylcholine, mivacurium, procaine, etc. […] A patients sensitivity towards succinylcholine makes him or her susceptible to harm and puts him or her at a health risk from anaesthesia. […] If you suffer from PCE deficiency, your first and foremost step should be informing your doctor or physician when they prescribe medications for you. […] Wearing a medical alert bracelet/necklace that indicates PCE deficiency will enable healthcare workers to realize your condition in the event of an accident/injury/surgery. […] If your surgeon/doctor is unaware of your pseudocholinesterase deficiency, then you may suffer from loss of breathing.

• #67 Pseudocholinesterase Deficiency and Patient Perspectives

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

  Pseudocholinesterase deficiency is usually diagnosed retrospectively after a patient has received general anesthesia with succinylcholine or mivacurium used for endotracheal intubation. […] To prevent future incidence of prolonged paralysis, patients with pseudocholinesterase deficiency should avoid succinylcholine and mivacurium. This involves properly educating patients on this new diagnosis. Another failsafe method to prevent reoccurrence is to list mivacurium and succinylcholine as sources of patient allergies or adverse reactions. Reoccurrence can also be deterred by a thoroughly conducted preoperative assessment by the anesthesia provider. Questions aimed at previous surgeries and issues with anesthesia in the past can elicit a history of pseudocholinesterase deficiency from patients.

• #68 Pseudocholinesterase Deficiency and Patient Perspectives

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

  Pseudocholinesterase deficiency is usually diagnosed retrospectively after a patient has received general anesthesia with succinylcholine or mivacurium used for endotracheal intubation. […] To prevent future incidence of prolonged paralysis, patients with pseudocholinesterase deficiency should avoid succinylcholine and mivacurium. This involves properly educating patients on this new diagnosis. Another failsafe method to prevent reoccurrence is to list mivacurium and succinylcholine as sources of patient allergies or adverse reactions. Reoccurrence can also be deterred by a thoroughly conducted preoperative assessment by the anesthesia provider. Questions aimed at previous surgeries and issues with anesthesia in the past can elicit a history of pseudocholinesterase deficiency from patients.

• #69 Pseudocholinesterase deficiency – GPnotebook

  https://gpnotebook.com/en-GB/pages/surgery/pseudocholinesterase-deficiency

  It is important to ask potential surgical candidates if they have had bad reactions to anaesthetics in the past. If recovery of muscle power was delayed then it is likely the patient has pseudocholinesterase deficiency. […] Patients who are given suxamethonium for surgery will remain paralysed for much longer than normal and may need ventilation for up to 24 hr. […] Once the patient has recovered, a genetic study should be carried out on the patient and relatives.

• #70 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. […] Diagnostic tests for pseudocholinesterase deficiency are not part of a routine preoperative work-up, and patients are typically asymptomatic in their daily lives. […] 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. […] To ensure a timely diagnosis, pseudocholinesterase deficiency must be included in the differential diagnosis of delayed emergence, and the combination of sustained paralysis despite indicators of increasingly light residual sedation or distress (that is, increasing EEG indices, tachycardia, and hypertension) should immediately raise suspicions of an abnormal response to mivacurium or succinylcholine. […] Once suspected, a clinical diagnosis can be supported using a peripheral nerve stimulator, and confirmed using laboratory tests, while genetic testing can help determine the etiology of disease.

• #71 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. […] Diagnostic tests for pseudocholinesterase deficiency are not part of a routine preoperative work-up, and patients are typically asymptomatic in their daily lives. […] 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. […] To ensure a timely diagnosis, pseudocholinesterase deficiency must be included in the differential diagnosis of delayed emergence, and the combination of sustained paralysis despite indicators of increasingly light residual sedation or distress (that is, increasing EEG indices, tachycardia, and hypertension) should immediately raise suspicions of an abnormal response to mivacurium or succinylcholine. […] Once suspected, a clinical diagnosis can be supported using a peripheral nerve stimulator, and confirmed using laboratory tests, while genetic testing can help determine the etiology of disease.

• #72

  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. […] Thanks to the detection of PCE levels is part of our pre-ECT assessments, it was possible for us to select rocuronium as the muscle relaxant to prevent complications. […] Thus we suggest the detection of PCE levels to be a part of routine pre-ECT laboratory assessments.

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