Abstract | OBJECTIVE: CASE SUMMARY: A 54-year-old female was admitted for surgical drainage of a groin abscess. She was given propofol 200 mg and succinylcholine 160 mg (1 mg/kg) intravenously to induce sedation and paralysis for endotracheal intubation. Thirty minutes after the 19-minute procedure, the patient showed no evidence of spontaneous recovery of respiration. She was transferred to the intensive care unit and 11 hours later was successfully weaned from the ventilator and extubated. A butyrylcholinesterase level of 552 IU/L (reference range 2673-6592) confirmed butyrylcholinesterase deficiency. Six months later, in compliance with institutional review board/human subjects research requirements, the patient returned for a dibucaine inhibition test and second butyrylcholinesterase assay; the butyrylcholinesterase level in the second assay was 789 IU/L. The dibucaine inhibition test result was 61.1% (reference range 81.6-88.3), suggesting that the adverse drug effect had a pharmacogenetic basis. Use of the Naranjo probability scale indicated a probable relationship between the prolonged neuromuscular paralysis and succinylcholine therapy in this patient. DISCUSSION: CONCLUSIONS:
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Authors | Scott E Kaufman, Robert W Donnell, David C Aiken, Caleb Magee |
Journal | The Annals of pharmacotherapy
(Ann Pharmacother)
Vol. 45
Issue 4
Pg. e21
(Apr 2011)
ISSN: 1542-6270 [Electronic] United States |
PMID | 21427295
(Publication Type: Case Reports, Journal Article)
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Chemical References |
- Butyrylcholinesterase
- Succinylcholine
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Topics |
- Apnea
- Butyrylcholinesterase
(deficiency)
- Female
- Humans
- Intubation, Intratracheal
(adverse effects, methods)
- Metabolism, Inborn Errors
(diagnosis)
- Middle Aged
- Neuromuscular Blockade
(adverse effects)
- Paralysis
(chemically induced)
- Succinylcholine
(administration & dosage, adverse effects)
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