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Butyrylcholinesterase deficiency or “I remember intubation”


Authors: D. Novotný 1,3;  J. Závada 2;  M. Novotná 3;  A. Bočková 3;  T. Vymazal 4
Authors‘ workplace: Klinika anesteziologie, resuscitace a intenzivní medicíny 1. lékařské fakulty Univerzity Karlovy a Ústřední vojenské nemocnice Praha 1;  Klinika anesteziologie, resuscitace a intenzivní medicíny 1. lékařské fakulty Univerzity Karlovy a Všeobecné fakultní nemocnice Praha 2;  VUAB Pharma, a. s., Roztoky 3;  Klinika anesteziologie, resuscitace a intenzivní medicíny 2. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Motol Praha 4
Published in: Anest. intenziv. Med., 33, 2022, č. 1, s. 51-54
Category: Case Reports

Overview

This case report describes a patient with a personal history of muscle paralysis after emergence from a short general anaesthesia with the use of suxamethonium. She has a partial recall of subsequent intubation. After a few hours of mechanical ventilation and sedation, she was extubated without complication in the ICU. During the preanesthesia evaluation, we suspected a deficiency of butyrylcholinesterase, an enzyme metabolizing mivacurium and suxamethonium. Due to that, general anaesthesia with muscle relaxation using rocuronium was performed for a planned hemithyreoidectomy. There were no complications during the surgery and subsequent genetic examinations revealed a combined mutation of the butyrylcholinesterase gene. Butyrylcholinesterase deficits increase the risk of perioperative respiratory complications. Testing of family members of patients with a confirmed mutation or preventive preoperative examination in high-risk surgery prevent such complications.

Keywords:

Apnea – Inborn errors of metabolism – suxamethonium – mivacurium – butyrylcholinesterase deficiency – neuromuscular monitoring


Sources

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Labels
Anaesthesiology, Resuscitation and Inten Intensive Care Medicine

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Anaesthesiology and Intensive Care Medicine

Issue 1

2022 Issue 1

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