PREOPERATIVE SERUM CHOLINESTERASE CONCENTRATION IN CHRONIC RENAL FAILURE: Clinical experience of suxamethonium in 81 patients undergoing renal transplant

Ryan, Danica

doi:10.1093/bja/49.9.945

Cited by 30 publications

(4 citation statements)

References 3 publications

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“…Patients with end‐stage renal failure have below normal levels of plasma cholinesterase. This results in a prolongation of action of the depolarizing muscle relaxant suxamethonium (83) and the non‐depolarizing relaxant mivacurium (84). A significant hyperkalemic response to suxamethonium is not observed in chronic renal failure provided the preoperative potassium level is within normal limits (85).…”

Section: Pharmacological Issues and Drug Choicesmentioning

confidence: 99%

Perioperative Management of the Hemodialysis Patient

Trainor¹,

Borthwick²,

Ferguson³

2011

Seminars in Dialysis

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Dialysis-dependent chronic kidney disease (CKD) is an expanding problem for healthcare systems worldwide. The prevalence of end-stage renal disease (ESRD) has increased by 20% since 2000 and stands at 1699 per million people in the USA. ESRD is associated with an increased risk of cardiovascular comorbidity, increased severity of cardiovascular disease, and an adjusted all-cause mortality rate that is 6.4-7.8-fold higher than the general population. These patients may present electively or emergently for surgery related to, or remote from, the CKD. In any perioperative setting, the patient with hemodialysis-dependent CKD represents a significant clinical challenge, and successful management of these patients requires effective cooperation and communication between nephrology, anesthesia, and surgical staff. The ESRD patient's nephrologist will have the best knowledge of their medical history, comorbidities, and future management goals and may have been the clinician who instigated the referral for the surgery, e.g., for parathyroidectomy, vascular access surgery, nephrectomy or renal transplantation. As such, they are in an ideal position to contribute to, or coordinate, early preoperative medical optimization of the patient and also to provide advice during postoperative recovery and rehabilitation. In this article, we provide an overview of some of the key aspects of managing these patients successfully during the perioperative period. We propose the integration of cardiopulmonary exercise testing and cardiovascular optimization into the care of these high-risk patients and provide an overview of the importance of maintaining microvascular perfusion and the role of viscosity in preserving the capillary perfusion network.

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Section: Pharmacological Issues and Drug Choicesmentioning

confidence: 99%

Perioperative Management of the Hemodialysis Patient

Trainor¹,

Borthwick²,

Ferguson³

2011

Seminars in Dialysis

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“…6 Low BChE activity is associated with hepatic and renal diseases. 7,8,9,10,11,12,13,14 If the acquired defects are excluded, low BChE activity is usually considered to be caused by mutations in butyrylcholinesterase gene (BCHE). 15 BChE deficiency is an autosomal recessive trait.…”

Section: Discussionmentioning

confidence: 99%

Pseudocholinesterase Deficiency in Patient Undergoing Microlaringeal Surgery

Marinov

Belitova

Popov³

et al. 2019

International Bulletin of Otorhinolaryngology

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Introduction: Pseudocholinesterase deficiency is a genetic or acquired alteration in the metabolism of choline esters such as succinylcholine. Case description: A 70 years old female patient (body weight 48 kg, height 157 cm) was admitted to the hospital for microlaryngeal surgery. The preoperative interrogation revealed no significant personal or family history of adverse reaction to anesthetics. ASA classification is III. We performed a general anesthesia with intubation to the patient. Fentanyl 0.25 mg, propofol 150 mg and succinylcholine 70 mg were administered for anesthesia induction. After intubation 2% sevoflurane was used for anesthesia maintenance. The patient was unresponsive to external stimuli for 40 min since the end of the operation. Tree hours after operation, the patient had totally recovered from paralysis and tracheal tube was removed. Four days after operation the patient was discharged from hospital with no special discomfort. Discussion: Reduced plasma cholinesterase activity may occur as a result of inherited, acquired defects or iatrogenic causes. If the acquired defects are excluded low butyrylcholinesterase enzyme (BChE) activity is usually considered to be caused by mutations in butyrylcholinesterase gene (BCHE). There is no specific treatment for butyrylcholinesterase deficiency and the mainstream is to maintain ventilatory support until succinylcholine is metabolized out of the myoneural junction and neuromuscular function recovers. Transfusion of fresh frozen plasma is also viable. Conclusion:There is no specific treatment for plasma cholinesterase deficiency. The best and safest way is to let the patient recover spontaneously. Mechanical ventilation support is very important.

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“…Both renal failure and liver disease are associated with reduced plasma cholinesterase activity [1, 2]; prolonged neuromuscular block following suxamethonium is possible in these conditions [3, 4]. Suxamethonium administration results in a mild and transient increase in serum potassium concentration.…”

Section: Pharmacology Of the Neuromuscular Blocking And Reversal Agenmentioning

confidence: 99%

Neuromuscular blocking drugs and their antagonists in patients with organ disease

Craig¹,

Hunter

2009

Anaesthesia

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Summary The pharmacodynamics and pharmacokinetics of the currently available neuromuscular blocking and reversal drugs may be altered by organ disease. Adverse effects such as prolonged neuromuscular block, postoperative residual curarisation, recurarisation, the muscarinic effects of the anticholinesterases, and the side‐effects of the antimuscarinics are encountered more frequently. This review will consider these potential problems and assess the role of sugammadex in enabling the anaesthetist to avoid them. It will also present the latest knowledge regarding the safety and efficacy of sugammadex in patients with renal, hepatic, cardiovascular and pulmonary disease.

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PREOPERATIVE SERUM CHOLINESTERASE CONCENTRATION IN CHRONIC RENAL FAILURE: Clinical experience of suxamethonium in 81 patients undergoing renal transplant

Cited by 30 publications

References 3 publications

Perioperative Management of the Hemodialysis Patient

Perioperative Management of the Hemodialysis Patient

Pseudocholinesterase Deficiency in Patient Undergoing Microlaringeal Surgery

Neuromuscular blocking drugs and their antagonists in patients with organ disease

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