Zencirci Beyazit
Department of Anesthesiology and Reanimation, Mostas Private Health Hospital, Kahramanmaras, Turkey.
Cases J. 2009 Dec 4;2:9148. doi: 10.1186/1757-1626-2-9148.
Pseudocholinesterase (butyrylcholinesterase) is a drug metabolizing enzyme responsible for hydrolysis of the muscle relaxant drugs succinylcholine and mivacurium. Deficiency from any cause can lead to prolonged apnoea and paralysis following administration of succinylcholine and mivacurium.
Within the last two years we have had four patients who have had prolonged apnea following the administration of mivacurium. It was understood that one was congenital and the other three due to various reasons had enzyme-deficiencies. In all four of the patients, the prolonged blocks deteriorated.
Prolonged blocks may be encountered due to mivacurium use. The diagnosis of pseudocholinesterase enzyme deficiency can be given after a careful clinic supervision and peripheral nerve stimulator monitoring. A decrease in the activity of pseudocholinesterase enzyme and improvement in neuromuscular function will help verifying our diagnosis. Instead of pharmacological applications that may further complicate the situation, what should be done in such patients is to wait until the block-effect goes down by the help of sedation and mechanical ventilation.
假性胆碱酯酶（丁酰胆碱酯酶）是一种药物代谢酶，负责水解肌肉松弛药物琥珀酰胆碱和米库氯铵。任何原因导致的该酶缺乏都可导致使用琥珀酰胆碱和米库氯铵后出现呼吸暂停和麻痹时间延长。
在过去两年中，我们有4例患者在使用米库氯铵后出现了长时间的呼吸暂停。据了解，其中1例为先天性，另外3例因各种原因存在酶缺乏。所有4例患者的长时间阻滞均恶化。
使用米库氯铵可能会出现长时间阻滞。在仔细的临床观察和外周神经刺激器监测后可诊断假性胆碱酯酶缺乏。假性胆碱酯酶活性降低和神经肌肉功能改善有助于证实我们的诊断。对于此类患者，不应采取可能使情况进一步复杂化的药物应用，而应在镇静和机械通气的帮助下等待阻滞效应消退。
