Hereditary pseudocholinesterase deficiency discovery after electroconvulsive therapy

Basant K Pradhan; Noud van Helmond; Ludmil V Mitrev; Angelo A Andonakakis

doi:10.1136/bcr-2020-239206

Hereditary pseudocholinesterase deficiency discovery after electroconvulsive therapy

BMJ Case Rep. 2021 Jan 18;14(1):e239206. doi: 10.1136/bcr-2020-239206.

Authors

Basant K Pradhan¹, Noud van Helmond², Ludmil V Mitrev³, Angelo A Andonakakis³

Affiliations

¹ Department of Psychiatry, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, New Jersey, USA.
² Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, New Jersey, USA vanhelmond-noud@cooperhealth.edu.
³ Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, New Jersey, USA.

Abstract

Inherited pseudocholinesterase deficiency refers to an uncommon defect in the butyrylcholinesterase enzyme which can result in prolonged muscle paralysis due to delayed breakdown of choline ester paralytic anaesthetic agents. We describe a 25-year-old woman receiving electroconvulsive therapy (ECT) for treatment of depression in whom motor function did not recover adequately after administration of succinylcholine. Investigated post-ECT, she was found to have severe pseudocholinesterase deficiency. Implications of pseudocholinesterase deficiency for ECT treatment and anaesthetic strategies are discussed.

Keywords: anaesthesia; psychiatry.

Publication types

Case Reports

MeSH terms

Adult
Apnea / diagnosis*
Butyrylcholinesterase / deficiency*
Depressive Disorder, Major / therapy*
Electroconvulsive Therapy*
Female
Humans
Metabolism, Inborn Errors / diagnosis*

Substances

Butyrylcholinesterase

Supplementary concepts

Butyrylcholinesterase deficiency