European Journal of Biomedical and Pharmaceutical Sciences

PROLONGED APNEA FOLLOWING SUCCINYLCHOLINE ADMINISTRATION – A CASE REPORT

Suhail Anjum Rather*, Dr. Abhishek Gupta and Dr. Shyamal Koley

ABSTRACT

We describe a case of prolonged apnea after an intubating dose of succinylcholine in a patient with an unsuspected deficit of serum cholinesterase. Succinylcholine apnea is usually apparent until the patient does not show any spontaneous respiratory efforts or change in vitals such as tachycardia, hypertension, or Carhart’s notch in capnograph since the last dose of injection succinylcholine. Prolonged apnea following succinylcholine administration was first reported in 1952. A most common cause of this are atypical serum cholinesterase (inherited), low serum cholinesterase (acquired), plasma cholinesterase antagonism, cerebral depression, hypocapnia, hypercapnia, metabolic acidosis, depression of lung stretch receptors or reflex laryngeal apnea. It can be managed by maintaining intermittent positive pressure ventilation (IPPV) and sedation to be maintained till the block wears off. Fresh Frozen Plasma (FFP) contains about 36-40 units/ml. blood or blood product transfusion, in 50% of individuals, has shown to decrease the duration of neuromuscular blockade in 10-15 min.

Keywords: Succinylcholine. Prolonged apnea. Serum cholinesterase.