Sertraline-induced pseudocholinesterase enzyme deficiency

Area of Science:

• Anesthesiology
• Pharmacogenetics

Background:

• Pseudocholinesterase is crucial for metabolizing muscle relaxants like succinylcholine.
• Deficiency can cause prolonged apnea and paralysis post-anesthesia.
• Sertraline use was noted in the patient's history.

Observation:

• A 47-year-old male undergoing laparoscopic cholecystectomy had a history of anesthesia without complications.
• He received succinylcholine in prior surgeries.
• This time, prolonged paralysis was observed post-administration.

Findings:

• The patient exhibited low plasma cholinesterase activity, indicating pseudocholinesterase deficiency.
• Diagnosis was supported by clinical observation and peripheral nerve stimulator monitoring.
• The prolonged neuromuscular block resolved over time with supportive care.

Implications:

• Highlights the importance of identifying pseudocholinesterase deficiency in patients with unexpected prolonged paralysis.
• Suggests supportive care (sedation, mechanical ventilation) is preferred over pharmacological intervention.
• Emphasizes careful patient monitoring to prevent complications in such cases.