Pseudocholinesterase Deficiency Uncovered During Electroconvulsive Therapy: Implications for Psychiatric Services

Area of Science:

• Anesthesiology
• Psychiatry

Background:

• Electroconvulsive therapy (ECT) is a vital treatment for acute suicidality in mental disorders.
• Modified ECT using muscle relaxants like succinylcholine can induce prolonged apnea in individuals with pseudocholinesterase deficiency.

Purpose of the Study:

• To report a case of prolonged apnea following modified ECT in a patient with undiagnosed pseudocholinesterase deficiency.
• To emphasize the importance of recognizing and managing pseudocholinesterase deficiency for safe ECT procedures.

Main Methods:

• A case report detailing a 24-year-old woman with schizophrenia and body dysmorphic disorder who experienced prolonged apnea post-ECT.
• Diagnostic testing confirmed possible inherited pseudocholinesterase deficiency.
• Anesthetic management was modified by substituting succinylcholine with atracurium.

Main Results:

• The patient developed prolonged apnea after modified ECT with succinylcholine.
• Subsequent testing revealed possible inherited pseudocholinesterase deficiency.
• Switching to atracurium allowed for the safe continuation of ECT.

Conclusions:

• Pseudocholinesterase deficiency is a rare but significant risk factor for prolonged apnea during modified ECT.
• Increased clinical awareness and preanesthetic screening are crucial for identifying individuals at risk.
• A clinical decision-making tree for anesthetic modifications can enhance the safety of ECT administration.