Prolonged postoperative apnea complicating gynecologic surgery; atypical cholinesterase and myasthenia gravis

Over a 10-year period 12,643 gynecologic surgical procedures were performed with the patients under general anesthesia. Succinylcholine was the muscle relaxant used in the majority of cases. Four of these patients developed prolonged postoperative apnea; the longest period of apnea was 6 hours. In one patient atypical cholinesterase was documented, and two of the patients were subsequently diagnosed as having myasthenia gravis. In the fourth case an etiology for the apnea was not demonstrated. A compilation of drugs in common clinical usage which interfere with neuromuscular transmission is included.