Reduced plasma cholinesterase following haemodilutional cardiopulmonary bypass

Abstract

SummaryThis case reporl presents a prolonged apnoea following the administration of suxarnethonium to a patient whose plasma cholinesterase concentrution was reduced as a consequence of haemodilutional cardiopulmonary bypass.

Cholinesterase Its significance in anaesthetic practice

“…Plasma cholinesterase levels decrease by an average of 56% as a result of haemodilutional cardiopulmonary bypass and this persists for 7 days following surgery [65]. This is claimed to be due entirely to the priming of the bypass machine as opposed to such factors as temperature variations or absorption in the bypass tubing or in-line filters.…”

Bloqueio neuromuscular prolongado após administração de mivacúrio: relato de caso

“…Há doenças que determinam decréscimo da atividade da colinesterase plasmática tais como hepatite, cirrose, colecistite, câncer com metástase a distância (principalmente de origem pulmonar, sistema genito-urinário e primário de intestino), desnutrição, insuficiência cardíaca grave, insuficiência renal, uremia e queimaduras extensas 9-12 . Ainda estão incluídas como causas de diminuição da atividade da pseudocolinesterase a plasmaférese, anticoncepcional oral, inibidores não competitivos da colinesterase (ecotiofato, organofosforados e ciclofosfamida), inibidores competitivos da colinesterase (neostigmina, edrofônio e piridostigmina), metoclopramida e pancurônio [13][14][15][16] . A metoclopramida inibe a colinesterase plasmática em até 70% do seu valor normal 3,17 .…”

“…S o m e d i s e a s e s d e t e r m i n e d e c r e a s e i n p l a s m a cholinesterase activity, such as hepatitis, cirrhosis, cholecystitis, cancer with distant metastasis (especially pulmonary, genito-urinary system and primary intestinal cancer), malnutrition, severe heart failure, renal failure, uremia and extensive burns 9-12 . Plasmaferesis, oral contraceptives, noncompetitive cholinesterase inhibitors (echothiophate, organop h o s p h o r a t e s a n d c y c l o s p h a m i d e ) , c o m p e t i t i v e cholinesterase inhibitors (neostigmine, edrophonium and pyridostigmine), metoclopramide and pancuronium are also responsible for pseudocholinesterase activity decrease [13][14][15][16] . Metoclopramide inhibits plasma cholinesterase in up to 70% of its normal value 3,17 .…”

Recovery from remifentanil after plasmapheresis in a paediatric patient with myasthenia gravis

“…In another study, Jackson et al. (15) found that there was a decrease in plasma cholinesterase activity of approximately 56% during cardiopulmonary bypass as a result of haemodilution and the decreased level of plasma cholinesterase persisting for 7 days following surgery. The replacement solution used in our patient also had a contributory effect on depletion of plasma cholinesterase enzyme as a result of dilution.…”

“…Although plasma cholinesterase levels were not determined in our patient, it is reasonable to assume that we managed anaesthesia in the presence of the effects of PP on plasma cholinesterase activity 5 days after the completion of multiple plasma exchanges based on previous reports (6,14,15). Naik et al.…”