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[Emergency from anesthesia in small children. From laryngospasm to prolonged apnea]
1Klinik für Anaesthesiologie der Universität Heidelberg. andre_gries@med.uni-heidelberg.de
Insights
A rare form of atypical pseudocholinesterase caused prolonged apnea in a child after succinylcholine administration for laryngospasm. This case highlights managing airway obstruction and delayed arousal reactions.
Area of Science:
- Anesthesiology
- Pharmacology
- Pediatric Critical Care
Background:
- Postoperative laryngospasm is a serious complication during anesthesia emergence.
- Successful management of laryngospasm can lead to other critical issues, such as prolonged apnea.
Observation:
- A 3.5-year-old boy developed laryngospasm during anesthesia emergence.
- Standard treatments failed, necessitating succinylcholine administration.
- This resulted in prolonged apnea requiring pediatric intensive care unit admission.
Findings:
- The patient experienced prolonged apnea due to dibucaine-sensitive, fluoride-resistant pseudocholinesterase, a rare atypical form.
- This enzyme deficiency explained the delayed arousal after succinylcholine.
Implications:
- This case underscores the importance of recognizing risk factors for perioperative airway obstruction.
- It highlights the need for careful management of prolonged apnea and delayed arousal reactions in pediatric patients.
- Understanding pseudocholinesterase variants is crucial for anesthetic drug administration and patient safety.
Abstract:
Postoperative laryngospasm during emergence from anaesthesia represents a potentially life-threatening complication. Even if this is successfully overcome using drug therapy, new, serious problems may develop. We report the case of a 3 1/2 -year-old boy of African descent weighing 15 kg who developed a laryngospasm during emergence from anaesthesia. Because the airway obstruction could not be controlled by deepening the anaesthesia again and administering anti-obstructive drugs, the boy was given 15 mg succinylcholine. Thereafter prolonged apnea developed such that the patient had to be admitted to the pediatric intensive care unit. The child was extubated 6 h later and the further course was normal so that he could be released from the hospital the following day. Further diagnostic study revealed a dibucaine-sensitive, fluoride-resistant pseudocholinesterase in the plasma, which is a rare form of atypical pseudocholinesterase, explaining the prolonged arousal phase after the administration of succinylcholine. Three significant aspects of this case are discussed: 1. risk factors and treatment of perioperative airway obstruction 2. factors and treatment of prolonged apnea, and 3. delayed arousal reactions and their management in an outpatient setting.