Pseudocholinesterase Deficiency Considerations: A Case Study

Abstract

Pseudocholinesterase deficiency, sometimes called butyrylcholinesterase deficiency, is a rare disorder in which the neuromuscular blocking drugs succinylcholine and mivacurium cannot be metabolized properly in the blood plasma. This disorder can either be acquired as a result of certain comorbidities or it can be inherited genetically. Anesthesia providers must understand the pathophysiology of pseudocholinesterase deficiency and be prepared to safely and effectively manage patients who show signs and symptoms consistent with the disorder after the use of the indicated neuromuscular blocking drugs. This article summarizes the pharmacologic and physiologic data relevant to understanding the basic pathophysiology associated with pseudocholinesterase deficiency and illustrates a case study of a young woman suspected of having the disorder after a prolonged delay in emergence from general anesthesia.

Keywords: Butyrylcholinesterase deficiency; Delayed emergence; General anesthesia; Pseudocholinesterase deficiency; Residual neuromuscular blockade.

Figure 1

Comparison of depolarizing and nondepolarizing blocks.

Figure 2

(A) Neuromuscular junction. (B) Muscle-type nicotinic acetylcholine receptor (N₁AChR).

Figure 3.

Molecular structures of acetylcholine and succinylcholine.