Plasma cholinesterase deficiency

Dell, Deena Damsky; Kehoe, Candice

doi:10.1016/s1089-9472(96)90086-6

Cited by 11 publications

(18 citation statements)

References 20 publications

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“…[7][8][9][10][11] A collaborative effort is required to review the case, interpret test results, determine the root cause of the event, and determine the source of plasma cholinesterase abnormality or deficiency.…”

Section: Discussionmentioning

confidence: 99%

“…Before extubation, patients should have a 4 of 4 TOF, a score of at least -1 or 0 on the Richmond Agitation Sedation Scale, good strength, and the ability to hold both legs off the bed for at least 5 seconds. 8,9,15 Prolonged paralysis and apnea due to mivacurium, which is a nondepolarizing NMBA with paralyzing effects that resolve with plasma cholinesterase hydrolysis, will no longer be an issue because the drug is no longer being manufactured. However, in the future, if other nondepolarizing NMBAs that are dependent on plasma cholinesterase metabolism are produced, nurses should be prepared to provide the same care as for patients with prolonged neuromuscular blockade from succinylcholine.…”

Section: Monitoring Effects Of Nmbasmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9]18 Nurses should recognize and report an abnormal dibucaine inhibition number and plasma cholinesterase levels. Additionally, nurses should not hesitate to discuss referral for genetic consultation when the dibucaine inhibition number is less than 80%.…”

Section: Nursing Skill Rationalementioning

confidence: 99%

See 2 more Smart Citations

Prolonged Paralysis and Apnea After Receiving a Neuromuscular Blocking Agent: What Nurses Should Know

Jaramillo

Scruth

Cheng

2009

American Journal of Critical Care

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After receiving mivacurium, a short-acting neuromuscular blocking agent used for intubation before surgery, a patient experienced prolonged paralysis and prolonged apnea that required ventilator support. Although this complication is rare, all critical care nurses should be aware of it so they can be competent in managing and providing holistic and comprehensive nursing care to the patient and the patient's family. Although this complication has been documented in the anesthesia literature, it has received little mention in critical care nursing journals. (American Journal of Critical Care. 2009;18:592,588-591) T his case report describes a patient who had prolonged paralysis and apnea after receiving mivacurium, a neuromuscular blocking agent (NMBA), for endotracheal intubation before surgery. This rare perioperative complication occurs in patients with plasma cholinesterase (pseudocholinesterase) deficiency. Most reported cases of prolonged paralysis are in patients receiving succinylcholine. In this case report, we discuss the use of both depolarizing and nondepolarizing muscle relaxants that undergo metabolism by plasma cholinesterase and the following critical care nursing issues: providing competent care for patients receiving NMBAs, management of acute prolonged paralysis and apnea, management of suspected plasma cholinesterase deficiency, strategies for prevention and patient safety, and future objectives for research. Case ReportA 56-year-old woman with a below-the-knee amputation of the right lower extremity was readmitted to the hospital for treatment of a 1-week-old stump that was dehisced and infected due to injury. Her medical history included chronic kidney disease treated with peritoneal dialysis, congestive heart failure, hypertension, neuropathy, peripheral vascular disease, diabetes, and malnourishment. The plan Continued on page 588Cases of Note features peer-reviewed case reports and case series that document clinically relevant findings from critical and high acuity care environments. Cases that illuminate a clinical diagnosis or a management issue in the treatment of critically and acutely ill patients and include discussion of the patient's experience with the illness or intervention are encouraged. Proposals for future Cases of Note articles may be e-mailed to ajcc@aacn.org. After induction and the start of maintenance anesthesia, the train of four (TOF) delivered by the peripheral nerve stimulator was 0 out of 4 twitches, indicating complete paralysis or 100% blockage of the acetylcholine receptors at the motor end plate. Because the patient's TOF did not return as expected and neuromuscular blockade could not be reversed, the surgical procedure was deferred and the patient was transferred to the intensive care unit (ICU) still intubated and mechanically ventilated for recovery from anesthesia. The prolonged paralysis was assumed to be due to plasma cholinesterase deficiency that resulted in extremely slow metabolism of mivacurium. By day 3, the patient's paralysis had compl...

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Section: Discussionmentioning

confidence: 99%

Section: Monitoring Effects Of Nmbasmentioning

confidence: 99%

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Prolonged Paralysis and Apnea After Receiving a Neuromuscular Blocking Agent: What Nurses Should Know

Jaramillo

Scruth

Cheng

2009

American Journal of Critical Care

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show abstract

“…7 Pseudocholinesterase deficiency is a rare genetic condition in which the body has a deficiency in the enzyme pseudocholinesterase, which is necessary for metabolism of succinylcholine and numerous anesthetic agents. 8 A patient with pseudocholinesterase deficiency has prolonged paralysis and requires mechanical ventilation until the agent wears off. The patient should be reassured, and sedatives and analgesics should be provided.…”

Section: Authormentioning

confidence: 99%

Safety of Patients Transferred From the Operating Room to the Intensive Care Unit

Kaplow

2013

Critical Care Nurse

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“…6 Pseudocholinesterase deficiency is a rare genetic condition where the body has a deficiency in that enzyme. 7 Pseudocholinesterase is necessary for metabolism of succinylcholine and numerous anesthetic agents. A patient with pseudocholinesterase deficiency has prolonged paralysis and requires mechanical ventilation until the succinylcholine wears off.…”

mentioning

confidence: 99%

Care of Postanesthesia Patients

Kaplow

2010

Critical Care Nurse

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Plasma cholinesterase deficiency

Cited by 11 publications

References 20 publications

Prolonged Paralysis and Apnea After Receiving a Neuromuscular Blocking Agent: What Nurses Should Know

Prolonged Paralysis and Apnea After Receiving a Neuromuscular Blocking Agent: What Nurses Should Know

Safety of Patients Transferred From the Operating Room to the Intensive Care Unit

Care of Postanesthesia Patients

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