Sage-Tips

Can I use local anesthetic on a patient with pseudocholinesterase deficiency?

The use of succinylcholine, mivacurium and ester local anesthetics must be avoided in patients with pseudocholinesterase deficiency because these patients may not be able to metabolize such anesthetics.

Which local anesthetic is metabolized by pseudocholinesterase?

Ester local anesthetics are predominantly metabolized by pseudocholinesterase.

What drugs should be avoided with pseudocholinesterase deficiency?

Drugs to avoid:

• Succinylcholine, also known as suxamethonium, which is commonly given to paralyse skeletal muscles as part of a general anaesthetic for surgery.
• Mivacurium, like succinylcholine, is a muscle relaxant and will have prolonged action in those with butyrylcholinesterase deficiency.

What reduces pseudocholinesterase activity?

Dibucaine (Nupercaine), a local anesthetic, will inhibit the activity of the normal enzyme to a greater extent than the atypical one, irrespective of the actual plasma levels of either. It inhibits normal pseudocholinesterase activity by 80\%, but inhibits the homozygous atypical enzyme by only 20\%.

What can affect pseudocholinesterase activity?

Pseudocholinesterase deficiency can be acquired as a result of conditions that reduce production of the pseudocholinesterase enzyme, such as chronic infections, kidney or liver disease, malnutrition, severe burns, cancer, or pregnancy. Certain drugs also can reduce production of the enzyme, causing a deficiency.

What other drugs are metabolized by pseudocholinesterase?

Neuromuscular Blocking Drugs Butyrylcholinesterase (BChE) or pseudocholinesterase is the enzyme that hydrolyzes neuromuscular blocking agents such as succinylcholine and mivacurium, as well as ester local anesthetic agents.

How do you test for pseudocholinesterase deficiency?

To diagnose inherited pseudocholinesterase deficiency, the abnormal gene that causes the condition are identified using genetic testing. A sample of your blood is collected and sent to a lab for analysis. Ask your doctor if family members should be tested before surgery as well.

Does pseudocholinesterase deficiency cause malignant hyperthermia?

A family history of malignant hyperthermia and pseudocholinesterase deficiency is critical. Malignant hyperthermia is a rare complication triggered by specific anesthetic agents and could be fatal if encountered; hence avoidance of potential triggering agents is paramount.

Do dentists use succinylcholine?

Succinylcholine is well known in oral and maxillofacial surgeon and dentist anesthesiologist practices, and it has a long history of successful use.

What enzyme breaks down anesthesia?

If you have pseudocholinesterase deficiency, your body lacks or has a reduced amount of the enzyme needed to break down (metabolize) drugs known as choline esters. These drugs, succinylcholine and mivacurium, are used as part of anesthesia to relax the muscles during medical procedures.

What is succinylcholine apnea?

Suxamethonium (succinylcholine) apnoea occurs when a patient has been given the muscle relaxant suxamethonium, but does not have the enzymes to metabolise it. Thus they remain paralysed for an increased length of time and cannot breathe adequately at the end of an anaesthetic.

How do you know if you have Pseudocholinesterase deficiency?

Pseudocholinesterase deficiency may be suspected when you have problems recovering muscle control and breathing after receiving the muscle relaxant succinylcholine or mivacurium as part of anesthesia. A blood test can be done to measure pseudocholinesterase enzyme activity.

What is pseudocholinesterase deficiency?

Pseudocholinesterase deficiency is a condition that causes increased sensitivity to certain muscle relaxant drugs used during general anesthesia (choline esters). These drugs relax the muscles used for movement, including those used for breathing.

How do you test for pseudocholinesterase activity?

A simplified screening test of pseudocholinesterase enzyme activity can be performed using the acholest test paper. When a drop of the patient’s plasma is applied to the substrate-impregnated test paper, a colorimetric reaction occurs.

What causes butyrylcholinesterase deficiency?

Pseudocholinesterase deficiency can be caused by mutations in the BCHE gene. This gene provides instructions for making the pseudocholinesterase enzyme, also known as butyrylcholinesterase, which is produced by the liver and circulates in the blood.

Why choose general anesthetic instead of local anesthetic?

There are a number of reasons why general anesthesia may be chosen over local anesthesia. In some instances, the patient is asked to choose between general and local anesthetic. This choice depends on age, state of health, and personal preference. The main reasons for opting for general anesthetic are: