Mollerup H M, Gätke M R
Danish Cholinesterase Research Unit, Department of Anaesthesiology, Copenhagen University Hospital, Herlev Hospital, Herlev, Denmark.
Acta Anaesthesiol Scand. 2011 Jan;55(1):82-6. doi: 10.1111/j.1399-6576.2010.02316.x. Epub 2010 Oct 4.
patients undergoing electroconvulsive therapy (ECT) often receive succinylcholine as part of the anesthetic procedure. The duration of action may be prolonged in patients with genetic variants of the butyrylcholinesterase enzyme (BChE), the most common being the K- and the A-variants. The aim of the study was to assess the clinical significance of genetic variants in butyrylcholinesterase gene (BCHE) in patients with a suspected prolonged duration of action of succinylcholine after ECT.
a total of 13 patients were referred to the Danish Cholinesterase Research Unit after ECT during 38 months. We determined the BChE activity and the BCHE genotype using molecular genetic methods, the duration of apnea, time to sufficient spontaneous ventilation and whether neuromuscular monitoring was used. The duration of apnea was compared with published data on normal subjects.
in 11 patients, mutations were found in the BCHE gene, the K-variant being the most frequent. The duration of apnea was 5-15 min compared with 3-5.3 min from the literature. Severe distress was noted in the recovery phase in two patients. Neuromuscular monitoring was used in two patients.
eleven of 13 patients with a prolonged duration of action of succinylcholine had mutations in BCHE, indicating that this is the possible reason for a prolonged period of apnea. We recommend objective neuromuscular monitoring during the first ECT.
接受电休克治疗（ECT）的患者在麻醉过程中常使用琥珀酰胆碱。对于丁酰胆碱酯酶（BChE）基因存在遗传变异的患者，琥珀酰胆碱的作用时间可能会延长，其中最常见的变异类型是K型和A型。本研究的目的是评估ECT后琥珀酰胆碱作用时间疑似延长的患者中，丁酰胆碱酯酶基因（BCHE）遗传变异的临床意义。
在38个月期间，共有13例患者在ECT后被转诊至丹麦胆碱酯酶研究单位。我们使用分子遗传学方法测定了BChE活性和BCHE基因型、呼吸暂停持续时间、达到充分自主通气的时间以及是否使用了神经肌肉监测。将呼吸暂停持续时间与已发表的正常受试者数据进行比较。
在11例患者中发现了BCHE基因的突变，其中K型变异最为常见。呼吸暂停持续时间为5 - 15分钟，而文献报道的时间为3 - 5.3分钟。两名患者在恢复阶段出现了严重不适。两名患者使用了神经肌肉监测。
13例琥珀酰胆碱作用时间延长的患者中有11例存在BCHE突变，这表明这可能是呼吸暂停时间延长的原因。我们建议在首次ECT期间进行客观的神经肌肉监测。
