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Heterozygotes for atypical cholinesterase.

H Owen, A R Hunter

British Journal of Anaesthesia

|April 1, 1983

Summary

Electroconvulsive therapy patients receiving suxamethonium can experience prolonged apnea. While eight patients were atypical gene heterozygotes, most with prolonged apnea showed only slight sensitivity, explaining the rarity of this genetic link.

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Area of Science:

Anesthesiology
Pharmacogenetics
Neurology

Background:

Electroconvulsive therapy (ECT) is a medical treatment.
Thiopentone and suxamethonium are commonly used anesthetic agents in ECT.
Prolonged apnea following suxamethonium administration is a rare but significant adverse event.

Purpose of the Study:

To investigate the incidence and genetic basis of prolonged apnea in patients undergoing ECT.
To determine the prevalence of atypical pseudocholinesterase (BuChE) gene variants in patients experiencing extended apnea after suxamethonium administration.

Main Methods:

Retrospective analysis of 332 patients undergoing ECT.
Identification of patients with apnea duration exceeding 240 seconds.
Biochemical testing to identify pseudocholinesterase (BuChE) enzyme variants, specifically atypical gene heterozygotes.

Main Results:

31 out of 332 patients (9.3%) exhibited prolonged apnea (>240 s) after suxamethonium.
Eight of these patients (25.8% of prolonged apnea cases) were identified as heterozygotes for the atypical BuChE gene.
The majority of patients with prolonged apnea were only slightly more sensitive to suxamethonium, suggesting other contributing factors beyond typical heterozygosity.

Conclusions:

Atypical pseudocholinesterase (BuChE) gene heterozygosity is not the sole or most common cause of prolonged apnea after suxamethonium in ECT.
The study highlights the complex pharmacogenetics of suxamethonium response and the need for further investigation into other contributing factors for prolonged apnea.

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