P042: DELAYED EMERGENCE AND DIBUCAINE NUMBER
Joann Bolton, Grace Cruz, E Rodrigues; Mayo Clinic Florida
Introduction/Background: A 63-year-old man with a history of delayed emergence following an upper enteroscopy presented for laparoscopic small bowel resection following diagnosis of a small bleeding mass requiring blood transfusions. Following his enteroscopy a month prior, he was extubated and transported to the recovery room. He was on a BIPAP for several hours due to hypercarbia. After several hours, he was discharged home.
Due to his history of slow emergence, midazolam was avoided prior to induction of anesthesia. Rapid sequence intubation using succinylcholine was performed due to active bleeding. His airway was secured and surgical procedure began. Throughout his procedure, it was observed that his train of four stimulation did not illicit a twitch response beyond 0/4. Because of this, he was kept intubated and sedated during transport to the recovery room and until he had full recovery of train of four 5 hours after administration of succinylcholine. At this time, he was extubated and monitored prior to transportation to the surgical floor.
Results: To verify this patient’s suspected slow metabolism of succinylcholine, a dibucaine number and pseudocholinesterase level was drawn. His dibucaine number was within normal ranges at 82, however his pseudocholinesterase level was 1252, where normal low is 3100. The patient was contacted about this finding and his wife informed us that his sister had a similar issue with anesthesia. They were advised that this deficiency is genetic and other family members may be at risk of having a prolonged effect from succinylcholine.
Discussion/Conclusion: This patient presented with prior history of respiratory failure following anesthesia suspicious for pseudocholinesterase deficiency. Classically, it is taught that a dibucaine level greater than 80 is homozygous normal, a level of 30-70 indicates a heterozygous atypical, and levels below 30 are homozygous atypical. Our patient presents with a normal range dibucaine number which demonstrates the importance of measuring the pseudocholinesterase levels when suspecting issues with metabolizing succinylcholine.