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Anesthesia

What is Pseudocholinesterase?

02/02/2009

Question:

After an operation on my 3 year old son a long time ago, he could not walk up. Only after 24 hours he woke up well enough to open 2 eyes and answer us. The operation was performed in Greece, in a private clinic. We arrived at 10 hrs and the operation was done at 14 hrs. They informed us that his "pseudo-cholesterini" were in quantity but of bad quality. Their message was that my son will probably not wake up from the next surgery. Therefore cannot be operated again.

My son is now 11 years old, healthy and very lively. Until now no surgery was anymore nessecary but my question is about the pseudo-cholesterinesterase that plays a role in the waking up after a surgery. For a long time now I`m trying to find information about that enzyme or hormone. Unfortunately nobody till now knows the Latin-translation of the greek phrase (including help of local doctors here in Greece.) Could you be so kind to inform me about this problem or at least inform me what the latin or english phrase for this pseudo-cholesterinesterase is?

In the worst case that my son has another operation, I can at least inform the doctor about it. Thank you in advance for your assistance.

Answer:

Thanks for your interesting question.

This is not a difficult problem to understand or to deal with, despite the problems you have had getting more accurate information.

Pseudocholinesterase, or plasma cholinesterase, is an enzyme made by the liver and present in the bloodstream. This enzyme is important only if you are given the drug called succinylcholine. Succinlycholine is a drug that causes paralysis, which allows the insertion of the breathing tube that is often essential for the safe conduct of anesthesia and surgery. (Don't try this at home!). The pseudocholinesterase that is normally in your bloodstream breaks down the succinylcholine quite quickly so that the effect usually lasts only about 5 minutes.

As far as I know there is no evidence that pseudocholinesterase has any other function in the body. So people deficient in pseudocholinesterase have no problems related to this deficiency until they are in the operating room and given the drug succinylcholine. This is rather strange but some say is proof that God, or nature, intended there to be anesthesiologists!

More detail: the quantity and quality of pseudocholinesterase in the body depends on genetics (genes, heredity). Both the amount and the quality of the enzyme can be measured in specialised laboratories. It is useful to have this information if your son has to have surgery in the future. It is not essential however because there are fortunately other drugs that can be substituted for succinylcholine. It is totally untrue that a person with pseudocholinesterase deficiency cannot have surgery.

The important thing is to have the problem named - written down preferably. The best place to write it down is on a bracelet or necklace that is worn permanently. In the United States an organization called MedicAlert offers these, as well as a system for recording the relevant medical information for retrieval in an emergency over the phone or internet. I am sure there are other such services in Europe and elsewhere.

Finally, even if succinlycholine is given to a person with the enzyme deficiency, this should not be life-threatening at all. It is simply necessary to continue to support the person's breathing (and keep them asleep) until the effect of the succinlycholine wears off by itself. This can take as long as 8 hours or more, but it does, definitely, wear off eventually.

For more information:

Go to the Anesthesia health topic, where you can:

Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University