Prolonged neuromuscular blockade as a result of malnutrition-induced pseudocholinesterase deficiency

Area of Science:

• Anesthesiology
• Pharmacology
• Biochemistry

Background:

• Mivacurium is a short-acting neuromuscular blocker used in surgery.
• Its action is terminated by plasma cholinesterase hydrolysis.
• Deficiencies in this enzyme can extend its effects.

Observation:

• A patient experienced prolonged apnea post-surgery after mivacurium administration.
• This occurred despite previous uneventful exposures to mivacurium and suxamethonium.
• The patient had an acquired deficiency in plasma cholinesterase.

Findings:

• Acquired plasma cholinesterase deficiency was identified as the cause of prolonged neuromuscular blockade.
• This led to unanticipated postoperative apnea.
• The patient's history of uneventful exposure masked the underlying deficiency.

Implications:

• Clinicians must consider acquired plasma cholinesterase deficiency in prolonged neuromuscular blockade, even with prior tolerance.
• This case underscores the need for vigilant monitoring in patients receiving neuromuscular blocking agents.
• Awareness of enzyme deficiencies is crucial for managing anesthetic complications.