Suxamethonium apnoea associated with plasmaphoresis

Area of Science:

• Anesthesiology
• Biochemistry

Background:

• Reduced serum cholinesterase activity can prolong neuromuscular blockade.
• Pregnancy and plasmapheresis are known factors that can decrease serum cholinesterase levels.

Observation:

• A patient experienced prolonged paralysis after suxamethonium administration.
• This was attributed to significantly reduced serum cholinesterase activity.

Findings:

• The patient's low cholinesterase levels were a consequence of both pregnancy and recent plasmapheresis.
• Had preoperative cholinesterase activity been measured, regional anesthesia could have been chosen over general anesthesia.

Implications:

• Measurement of serum cholinesterase activity is recommended for patients undergoing plasmapheresis before anesthesia involving suxamethonium.
• This proactive testing can prevent prolonged neuromuscular blockade and associated complications.
• Optimizing anesthetic choices based on individual patient biochemistry is crucial for patient safety.