Prolonged apnea after orthognathic surgery due to atypical cholinesterase

Prolonged apnea (9 hours) after elective orthognathic surgery occurred in a healthy adult female. The patient had previously undergone multiple general anesthetics without any adverse reactions or complications. Measurement of the patient's serum postoperatively confirmed both a qualitative and quantitative defect in the cholinesterase enzyme. The genetic background for an atypical cholinesterase phenotype is briefly reviewed. Treatment modalities for this rare condition are also discussed.