Effect of Pancuronium, Vecuronium and Atracurium to the Plasma Cholinesterase Activity / 대한마취과학회지

BACKGROUND: Succinylcholine is metabolized by plasma cholinesterase (PChE). When it was pretreated by small doses of nondepolarizing muscle relaxants in order to minimize the side effects, there are evidences to be associated with alteration in the duration of action. This study is investigated whether the responses would be related to the enzymatic activities. METHODS: In 21 adult patients, ASA class I or II, PChE levels were measured by the modified Garry method after induction of anesthesia (control value) and at 3, 10, 20 and 30 min following administration of pancuronium 0.1 mg/kg, vecuronium 0.1 mg/kg and atracurium 0.5 mg/kg. Data were expressed as mean (SEM). RESULTS: The levels of PChE were significantly lower (p<0.05) than the control values at 3, 10, 20 and 30 min after given pancuronium as 4764 (270), 4777 (261), 4796 (306) and 4740 (332) IU/L respectively and after given vecuronium as 5004 (341), 5051 (329), 4969 (340) and 4960 (340) IU/L respectively whereas enzyme levels after given atracurium were not significant differences to compare the control values as 5153 (336), 5136 (320) 5124 (312) and 5151 (275) respectively. CONCLUSIONS: The results of present study show that both pancuronium and vecuronium may possibly inhibit PChE activity but this was not affected by atracurium.

Prolonged Apnea after Cesarean Section in Patient with Low Level of Plasma Cholinesterase Activity: A case report / 대한마취과학회지

Succinylcholine-induced prolonged neuromuscular blockade may occur in patients with either a low level of plasma cholinesterase activity or genotypically abnormal form of that enzyme. We experienced a case of succinylcholine-induced prolonged apnea due to a low level of plasma cholinesterase activity. A 31-year-old woman, full term primigravida, underwent cesarean section for breech presentation under general anesthesia. Familial and past medical history were nonspecific and preoperative physical and laboratory findings were within normal range. After operation, delayed apnea was detected and lasted for about one hour. We performed controlled and assisted ventilation for two and half hours. Plasma cholinesterase activity measured 30.00 IU/L (colorimetric method, normal value: 1130~1960 IU/L) at the first postoperative day. She was discharged on 7th postoperative day without any sequelae. From follow-up study after six months, it measured 1.02 U/ml (EIA, normal value: 7~9 U/ml).