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Acquired pseudocholinesterase deficiency after high-dose cyclophosphamide
V Koseoglu1, J Chiang, K W Chan
1Division of Pediatrics, University of Texas MD Anderson Cancer, Houston, TX, USA.
Bone Marrow Transplantation
|January 11, 2000
Summary
High-dose cyclophosphamide chemotherapy can cause severe pseudocholinesterase (PSC) deficiency, prolonging the effects of succinylcholine anesthesia. This case highlights the risk of neuromuscular blockade after chemotherapy.
Area of Science:
- Anesthesiology
- Pharmacology
- Oncology
Background:
- Pseudocholinesterase (PSC) is crucial for metabolizing succinylcholine, a common anesthetic neuromuscular blocker.
- Reduced PSC activity can lead to prolonged paralysis and apnea after succinylcholine administration.
- Cyclophosphamide is known to inhibit PSC, with potential dose-dependent effects.
Observation:
- A patient receiving high-dose cyclophosphamide (7 g/m2) developed severe PSC deficiency.
- Nine hours post-chemotherapy, the patient received succinylcholine for anesthesia.
- This resulted in unexpectedly prolonged apnea, indicating sustained succinylcholine action.
Findings:
- High-dose cyclophosphamide can induce significant, dose-dependent pseudocholinesterase deficiency.
- This deficiency can manifest as prolonged neuromuscular blockade when succinylcholine is administered post-chemotherapy.
- The timing of succinylcholine administration relative to cyclophosphamide is critical.
Implications:
- Clinicians should be aware of the risk of drug-induced PSC deficiency following high-dose cyclophosphamide.
- Caution is advised when using depolarizing neuromuscular relaxants like succinylcholine shortly after high-dose chemotherapy.
- Monitoring PSC activity or considering alternative anesthetic agents may be warranted in such cases.
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