pseudocholinestrase deficiency

[phat_ass]

anyone ever give FFP for the defeiciency? How much FFP would it take to reverse succinylcholine effect from a deficiency?

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[jetproppilot]

anyone ever give FFP for the defeiciency? How much FFP would it take to reverse succinylcholine effect from a deficiency?

The risk of transfusion (reaction, hep c, etc) outweighs the benefit of saving the patient a few hours on the vent post op.

 

[VolatileAgent]

The risk of transfusion (reaction, hep c, etc) outweighs the benefit of saving the patient a few hours on the vent post op.

yes. agreed. you just leave 'em tubed, let it wear off, and give 'em a letter so the next schlub who does his anesthetic doesn't do the same thing. if you want to get real fancy, you can send him to figure out what his dibucaine number is. and, ffp would indeed work, but there's no real good reason to give it. i'd imagine you start with one unit, see if they got twitches back, then give more as necessary.

 

[MTGas2B]

Agreed with above. The one time, so far, I've run across this just let them ride it out. Once you figure out what you're dealing with it's more important that you keep them intubated, and keep them asleep than worry about how to speed up the sux wearing off.

 

[rn29306]

This happened to me at an ASC located in the parking lot of the main hospital. Middle-aged female received mivacron at approximately 1300 for a short surgery. She didn't wake up but the lack of breathing or TOF was the kicker...after confirming with my forearm the TOF monitor was indeed shocking the piss outta me. Put her back down with a propofol gtt. Found out the hospital could run an in-house plasma level of psuedocholinesterase...normal level for this facility was 9-16 units / ml (I think). Drew blood and her level was 2. Kept her sedated with propofol until late that evening and she was transferred to the main facility ICU to ride it out until extubation the next morning. No recall of the events.

My only experience with this.

 

[Noyac]

If you know that they have a pseudo def just give them mivacron.

Just kidding, I had a crna give mivacron b/c he was doing a short cse on someone with a pseudo def. He won't ever do that again.

 

[rn29306]

If you know that they have a pseudo def just give them mivacron.

Just kidding, I had a crna give mivacron b/c he was doing a short cse on someone with a pseudo def. He won't ever do that again.

It was an unknown diagnosis and she never received either ester based relaxants...

What sucked even worse was this was a personal friend of the anesthesiologist and he pushed it.

Unknown diagnosis sucks....esp on your buds.

 

[Noyac]

rn, I didn't see either of your posts here when answering your PM. Now I bet you were thinking I was ******ed.

 

[rn29306]

Naw man. It was kinda laggy just then and I figure'd I would thow that second post in to further explain it.

I knew you hadn't read it by your response to the PM.

 

[Monty Python]

Agreed with above. The one time, so far, I've run across this just let them ride it out. Once you figure out what you're dealing with it's more important that you keep them intubated, and keep them asleep than worry about how to speed up the sux wearing off.

We had a lot of farmers and rural people in our clientele at my former charity hospital gig way out in the boonies. At least twice a year we'd get someone with heavy lifetime exposure to organophosphates take forever to recover from sux. We ran dibucaine numbers on everyone - some came back as normal.

 

[Noyac]

We had a lot of farmers and rural people in our clientele at my former charity hospital gig way out in the boonies. At least twice a year we'd get someone with heavy lifetime exposure to organophosphates take forever to recover from sux. We ran dibucaine numbers on everyone - some came back as normal.

Does atropine help in this situation? I seem to remember atropine being the treatment for organophosphate poisoning. I may be way off, here.

 

[dr. mccoy]

Does atropine help in this situation? I seem to remember atropine being the treatment for organophosphate poisoning. I may be way off, here.

No. Pseduocholinesterase deficiency is not helped with an anticholinergic compound. Nor is transfusing a blood product indicated in this situation. Agree with prolonged intubation with sedation.

 

[Monty Python]

Does atropine help in this situation? I seem to remember atropine being the treatment for organophosphate poisoning. I may be way off, here.

I believe you're remembering part of the treatment for acute organophosphate poisioning. The military gives us autoinjectors (with monstrous needles to go through chemical warfare suits).

2-Pralidoxime (called 2-PAM = enzyme that reverses cholinesterase inhibition) followed by atropine to avoid the SLUDE syndrome.

 

[Noyac]

I believe you're remembering part of the treatment for acute organophosphate poisioning. The military gives us autoinjectors (with monstrous needles to go through chemical warfare suits).

2-Pralidoxime (called 2-PAM = enzyme that reverses cholinesterase inhibition) followed by atropine to avoid the SLUDE syndrome.

Yes. SLUDE
salivation, lacrimation, urination, defaectation(?), and what's E? Ejaculation? Erection? What ever it is, it would suck.

 

[Monty Python]

Yes. SLUDE
salivation, lacrimation, urination, defaectation(?), and what's E? Ejaculation? Erection? What ever it is, it would suck.

E = uninhibited CNS excitation, which is why they also give us valium autoinjectors to follow the 2-PAM and atropine, if needed.

That way you won't know or care that you're suffocating, or that the enemy is about to use you for target practice.

 

[psychbender]

E = Emesis

and G = Gastric Motility (or GI distress, or GI irritation)

 

[Monty Python]

E = Emesis

and G = Gastric Motility (or GI distress, or GI irritation)

Yes, thanks.

I was thinking back to military training, where SLUDE is slightly bastardized. The E in that scenario refers euphamistically to excitation. But you are correct, above.