[Prolonged apnea after administration of succinylcholine].

INTRODUCTION

Succinylcholine is a depolarizing muscle relaxant that has been used for five decades in clinical practice. It is decomposed by enzyme acetylcholinesterase, which is synthesized in posed by enzyme acetylcholinesterase, which is synthesized in the liver. This process lasts a few minutes, and is prolonged in the case of hepatic failure of the liver function, in normal pregnancy and puerperium, in persons with lack of this enzyme or genetic anomaly in its composition.

CASE REPORT

The patient, a 31 years old woman, was exposed to diagnostic biopsy of endometrium during treatment of primary infertility. She received classic short-term general anaesthesia and 1 mg/kg (50 mg) of succinylcholine. Breathing was completely restored after 90 minutes. Eventually we found out that in previous three anaesthesias she showed the same dysfunction. It was laboratory proven that she had a decrease in contents of acetylcholinesterase in plasma (20 mukat/l). The possibility of genotype investigation does not exist in our country. The patient was introduced in detail with the nature of her disability.

DISCUSSION

The activity of enzyme acetylcholinesterase depends on functional state of the liver, as well as the therapy with some drugs (cyclophosphamide, ecothiopate etc.). For the anaesthetic practice the most important is the presence of abnormal acetylcholinesterase. The incidence of recessive homozygotes is 1:1500-1:3000 cases in the total population and the apnea lasts for 1-2 hours, and sometimes even 4-8 hours. Every apnea over 15 minutes requires maximal attention of the anesthesiologist. First it is necessary to eliminate other possible causes of apnea. The therapy is based on oxygenation with 100% O2 blood transfusion or transfusion of fresh frozen plasma or preparation of human acetylcholinesterase.

CONCLUSION

The case of the patient with prolonged postsurgical apnea indicates the decisive significance of comprehensive preanaesthetic anamnesis, both in serious surgical and in clinical interventions. Since there is no adequate substitution for succinylcholine, nowadays it is still in use in clinical practice.