Prolonged neuromuscular blockade and awareness during general anaesthesia, after administration of succinylcholine: Butyrylcholinesterase deficiency

Succinylcholine is a current and well-tolerated drug in general anaesthesia. However, it can lead to prolonged phase II neuromuscular block in case of pseudocholinesterase deficiency. We report the case of a 61-year-old female patient who presented prolonged apnea for a while after the hypnotic was stopped at the end of surgery, after being exposed to succinylcholine. As a consequence, the duration of invasive ventilation was prolonged for more than six hours. She also experimented awareness during this period. The plasma pseudocholinesterase level in the patient was low, confirming pseudocholinesterase deficiency. This case underlines how important it is to have the possibility to assess neuromuscular blockade with peripheral nerve stimulator. We also mention how to take care of patient with unexpected pseudocholinesterase deficiency: management, biological diagnosis, information to patient and family.