Naik Bhiken, Hirshhorn Steven, Dharnidharka Vikas R
Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610, USA.
J Clin Anesth. 2002 Aug;14(5):381-4. doi: 10.1016/s0952-8180(02)00382-3.
Plasmapheresis is a well-known therapeutic procedure for several medical conditions in which removal of circulating antibodies or albumin-bound toxins is desired. Circulating plasma cholinesterase enzyme levels are also depleted with plasmapheresis. This action causes patients to be susceptible to prolonged neuromuscular blockade when neuromuscular blocking drugs that are metabolized by this enzyme are used. We describe a case of prolonged neuromuscular blockade following succinylcholine and mivacurium administration in a 24-year-old renal transplant patient undergoing repeated plasmapheresis for recurrence of focal segmental glomerulosclerosis and acute vascular rejection. Serum and plasma cholinesterase levels were less than 20% of normal at the time of the event. The patient had spontaneous recovery after 12 hours of conservative supportive care. She tolerated a similar procedure uneventfully two weeks later when she was not taking plasmapheresis. Anesthesiologists should be aware of plasmapheresis as a mechanism for plasma cholinesterase depletion when using neuromuscular blocking drugs that are metabolized by this enzyme.
血浆置换是一种治疗多种疾病的知名方法，适用于需要清除循环抗体或与白蛋白结合毒素的情况。血浆置换也会使循环中的血浆胆碱酯酶水平降低。当使用可被该酶代谢的神经肌肉阻滞剂时，这一作用会使患者易于出现神经肌肉阻滞时间延长的情况。我们描述了一名24岁肾移植患者的病例，该患者因局灶节段性肾小球硬化复发和急性血管排斥反应接受重复血浆置换，在给予琥珀酰胆碱和米库氯铵后出现了长时间的神经肌肉阻滞。事件发生时，血清和血浆胆碱酯酶水平低于正常水平的20%。经过12小时的保守支持治疗后，患者实现了自主恢复。两周后，当她未进行血浆置换时，顺利耐受了类似的手术。麻醉医生在使用可被该酶代谢的神经肌肉阻滞剂时，应意识到血浆置换是导致血浆胆碱酯酶耗竭的一种机制。
