Prolonged apnea during electroconvulsive therapy in monozygotic twins: case reports

Area of Science:

• Anesthesiology
• Clinical Genetics
• Pharmacology

Background:

• Electroconvulsive therapy (ECT) is a medical treatment most often used for patients with severe major depression or bipolar disorder that has not responded to other treatments.
• Anesthesia is commonly used during ECT to ensure patient safety and comfort.
• Prolonged apnea, a temporary cessation of breathing, can be a rare but serious complication of anesthesia.

Purpose of the Study:

• To report two cases of monozygotic twins experiencing prolonged apnea during ECT.
• To investigate the underlying cause of prolonged apnea in these twins.
• To highlight the potential role of butyrylcholinesterase (BCHE) deficiency in anesthesia complications during ECT.

Main Methods:

• Case report of monozygotic twins undergoing ECT.
• Dibucaine number test to assess butyrylcholinesterase (BCHE) activity.
• Polymerase chain reaction (PCR) based genetic analysis of the BCHE gene.

Main Results:

• Both twins developed prolonged apnea post-administration of succinylcholine during ECT.
• Dibucaine number tests confirmed butyrylcholinesterase (BCHE) deficiency in both individuals.
• Genetic analysis revealed heterozygous combined A and K variant mutations in the BCHE gene for both twins.

Conclusions:

• Butyrylcholinesterase (BCHE) deficiency poses a significant risk for prolonged apnea during anesthesia, particularly in the context of ECT.
• Genetic factors, specifically heterozygous mutations in the BCHE gene, can contribute to this deficiency.
• Awareness of BCHE deficiency is crucial for anesthesiologists managing patients undergoing ECT to prevent and manage potential complications.