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Suxamethonium apnoea and the isolated leg
J B Mitchell1, W Harrop-Griffiths
1Department of Anaesthesia, St Mary's Hospital, London.
Anaesthesia
|April 1, 1994
Summary
Patients with atypical pseudocholinesterase genotypes receiving suxamethonium experienced prolonged neuromuscular block. This suggests the block
Area of Science:
- Anesthesiology
- Pharmacology
- Genetics
Background:
- Describes the anesthetic management of a patient with an unknown homozygous atypical pseudocholinesterase genotype.
- Suxamethonium administration was performed following the application of an arterial tourniquet to the patient's right leg.
Observation:
- Following tourniquet release and anesthetic termination, the patient could move their right leg but no other body parts.
- This localized motor function recovery was verified using a peripheral nerve stimulator and patient recall.
Findings:
- The patient exhibited a prolonged neuromuscular block after suxamethonium administration, consistent with atypical pseudocholinesterase activity.
- Recovery of motor function was observed in the limb distal to the tourniquet, while other limbs remained affected by the neuromuscular block.
Implications:
- Suggests that the prolonged neuromuscular block in patients with atypical pseudocholinesterases is due to sustained effects at the neuromuscular junction.
- Challenges the notion that the continuing presence of suxamethonium in plasma is the sole cause of prolonged block.
- Highlights the importance of understanding pseudocholinesterase genotypes in anesthetic practice.