Pseudocholinesterase Deficiency
Pseudocholinesterase deficiency is an acquired or inherited defect in the pseudocholinesterase enzyme, resulting in prolonged effects of pseudocholinesterase metabolized agents including succinylcholine, mivacurium, and ester local anesthetics. Duration of prolonged action of the aforementioned drugs depends upon a homozygous or heterozygous atypical pseudocholinesterase enzyme. The degree of pseudocholinesterase deficiency in at risk patients can be objectively assessed by measuring the dibucaine number (% of PChE enzyme activity inhibited by dibucaine) and the PChE enzyme activity. An interpretation of these tests is as follows:
Normal values: Total PChE (2900-7100 U/L), Dibucaine number of at least 80
Variable risk of prolonged paralysis: Normal to decreased PChE activity, Dibucaine number 30-80
High risk of prolonged paralysis: Decreased PChE activity, Dibucaine number <30
Treatment of prolonged paralysis from administration of triggering agents in a patient with pseudocholinesterase deficiency includes mechanical ventilation and respiratory support until resolution of neuromuscular blockade.
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Relevant Article Depot:
Pseudocholinesterase Deficiency
Pseudocholinesterase, Dibucaine Inhibition]
Pseudocholinesterase Deficiency Considerations: A Case Study