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Prolonged Apnoea after Suxamethonium: An Analysis of the First 225 Cases Reported to the Danish Cholinesterase Research Unit
Author(s) -
VibyMogensen J.,
Hanel H. K.
Publication year - 1978
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.1978.tb01313.x
Subject(s) - medicine , cholinesterase , hyperventilation , depression (economics) , gastroenterology , danish , anesthesia , physiology , endocrinology , economics , macroeconomics , linguistics , philosophy
During the last 4 years, 225 patients have been referred to the Danish Cholinesterase Research Unit following an episode of prolonged apnoea after suxaniethonium. Fourteen patients (6.2%) were found to have a low serum cholinesterase activity due to an acquired deficiency (for instance, liver disease, chronic debilitating disease or carcinoma). One hundred and forty‐eight patients (65.8%) had an inherited abnormal serum cholinesterase, and 105 of these patients (46.7%) were homozygous for the atypical enzyme (E 1 E 1 a ). The mean period of apnoea in this latter group was 92 min (range: 25–240). Seventeen patients (7.6%) were heterozygous for the normal and the atypical enzyme (E 1 Y E 1 a ), with a mean apnoea period of 25 min (range: 7–60 min). Twelve patients were found to be heterozygous for the atypical and the silent gene (E 1 a E 1 s ). The mean period of apnoea was 126 rnin (range: 45–210 min). Fourteen patients had other rare genotypes. The longest mean period of apnoea (170 min, range: 70–330) was found in patients homozygous for the silent gene (E 1 s E 1 s ). The silent gene and the fluoride‐resistant gene were found in 8.9% and 2.7% of the patients, respectively. In 63 patients (28.1%) both the type and quantity of serum cholinesterase were normal. In 34 of these patients (15.2%), the prolonged apnoea was due to other causes; for example, suxamethonium overdose, hyperventilation and central as well as peripheral respiratory depression. However, in the other 29 patients (12.9%), the reason for the prolonged apnoea could not be established. The possibility therefore exists that these cases represent unknown genotypes.