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Prolonged apnea following modified electroconvulsive therapy with suxamethonium
1Consultant Anesthesiologist, ASHA Hospital, Banjara Hills, Hyderabad, India.
Indian Journal of Psychological Medicine
|February 21, 2012
Summary
Patients with recent organophosphate poisoning may experience prolonged apnea after suxamethonium administration due to low butyrylcholinesterase levels. Testing enzyme levels and avoiding suxamethonium is crucial in such cases.
Area of Science:
- Anesthesiology
- Toxicology
- Pharmacology
Background:
- A patient with a history of organophosphate poisoning required Electroconvulsive Therapy (ECT).
- Organophosphate poisoning can affect enzyme levels crucial for anesthesia.
- Relatives concealed the patient's prior medical history.
Observation:
- Modified ECT was administered using thiopentone and suxamethonium.
- The patient experienced prolonged apnea for 2 hours post-suxamethonium.
- Previous records revealed very low butyrylcholinesterase levels (350 u/l).
Findings:
- Prolonged suxamethonium-induced apnea is a risk in patients with recent organophosphate poisoning.
- Low butyrylcholinesterase levels, resulting from organophosphate exposure, impair suxamethonium metabolism.
- Concealed medical history can lead to adverse anesthetic events.
Implications:
- Anesthesiologists must inquire about recent organophosphate exposure before administering suxamethonium.
- Measuring butyrylcholinesterase levels is recommended for patients with a history of organophosphate poisoning.
- Avoiding suxamethonium in patients with low butyrylcholinesterase levels is essential for patient safety.
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