Anest. intenziv. Med. 2022;33(1):51-54 | DOI: 10.36290/aim.2022.005

Butyrylcholinesterase deficiency or "I remember intubation"Case Report

Novotný D.^{1, 3}, Závada J.², Novotná M.³, Bočková A.³, Vymazal T.⁴

¹ Klinika anesteziologie, resuscitace a intenzivní medicíny 1. lékařské fakulty Univerzity Karlovy a Ústřední vojenské nemocnice Praha

² Klinika anesteziologie, resuscitace a intenzivní medicíny 1. lékařské fakulty Univerzity Karlovy a Všeobecné fakultní nemocnice Praha

³ VUAB Pharma, a. s., Roztoky

⁴ Klinika anesteziologie, resuscitace a intenzivní medicíny 2. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Motol Praha

This case report describes a patient with a personal history of muscle paralysis after emergence from a short general anaesthesia with the use of suxamethonium. She has a partial recall of subsequent intubation. After a few hours of mechanical ventilation and sedation, she was extubated without complication in the ICU. During the preanesthesia evaluation, we suspected a deficiency of butyrylcholinesterase, an enzyme metabolizing mivacurium and suxamethonium. Due to that, general anaesthesia with muscle relaxation using rocuronium was performed for a planned hemithyreoidectomy. There were no complications during the surgery and subsequent genetic examinations revealed a combined mutation of the butyrylcholinesterase gene. Butyrylcholinesterase deficits increase the risk of perioperative respiratory complications. Testing of family members of patients with a confirmed mutation or preventive preoperative examination in high-risk surgery prevent such complications.

Keywords: suxamethonium, mivacurium, butyrylcholinesterase deficiency, apnea, neuromuscular monitoring, inborn errors of metabolism.

Received: November 2, 2021; Revised: January 19, 2022; Accepted: February 1, 2022; Published: February 25, 2022  Show citation