It is important to ask potential surgical candidates if they have had bad reactions to anaesthetics in the past. If recovery of muscle power was delayed then it is likely the patient has pseudocholinesterase deficiency.
Pseudocholinesterase is a family of enzymes which are widely distributed throughout the body including plasma, liver, skin and gastrointestinal tract.
Pseudocholinesterase is less specific for acetylcholine and will hydrolyse other esters, including important drugs:
Patients who are given suxamethonium for surgery will remain paralysed for much longer than normal and may need ventilation for up to 24 hr.
Recently the abnormal gene responsible for this condition has been identified as being on chromosome 9. Different allelic combinations result in a spectrum of enzyme activity.
Once the patient has recovered, a genetic study should be carried out on the patient and relatives.
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