Low Pseudocholinesterase Levels
Pseudocholinesterase deficiency is a rare genetic disorder, where there is a deficiency of the enzyme pseudocholinesterase. It makes a person sensitive to any anesthetic agents, especially succinylcholine. It is used as a muscle relaxant during surgery.
Doctors recognize this condition when respiratory paralysis persists for a prolonged time with a normal dose of succinylcholine during the surgery.
Ventilator support is required till the excess of succinylcholine is metabolized and normal breathing is resumed.
Symptoms of Pseudocholinesterase Deficiency
- Prolonged apnea after the surgery.
- Respiration becomes difficult during the time of surgery, which an aesthetician can make out.
There is no characteristic physical finding from which the deficiency of pseudocholinesterase can be made out. It is only through the past history of an episode during the surgery a doctor is able to know about it.
It is commonly seen in people of European origin.
Besides hereditary, low plasma pseudicholinesterase deficiency can occur in conditions such as: liver disease, tuberculosis, malignancy, uremia, burns, and pesticide poisoning.
Treatment for Pseudocholinesterase Deficiency
- Laboratory diagnosis can be made by blood assays of pseudocholinesterase enzyme activity.
- A screening test can be performed by the use of acholest test paper.
- Mechanical ventilator support is necessary, until the effect of succinylcholine fades away, and the patient starts to breathe on his own.
- Transfusion of fresh frozen plasma in perioperative stage can mask the underlying pseudocholinesterase deficiency.
Differential diagnosis of pseudocholinesterase deficiency:
- Myasthenia gravis.
- Phase -2 neuromuscular block, due to high dose of succinylcholine.