Reversal of succinylcholine induced apnea with an organophosphate scavenging recombinant butyrylcholinesterase

An Accessible Yarn-Based Sensor for In-Field Detection of Succinylcholine Poisoning

Succinylcholine (SUX) is a clinical anesthetic that induces temporary paralysis and is degraded by endogenous enzymes within the body. In high doses and without respiratory support, it results in rapid and untraceable death by asphyxiation. A potentiometric thread-based method was developed for the in-field and rapid detection of SUX for forensic use. We fabricated the first solid-contact SUX ion-selective electrodes from cotton yarn, a carbon black ink, and a polymeric ion-selective membrane. The electrodes could selectively measure SUX in a linear range of 1 mM to 4.3 μM in urine, with a Nernstian slope of 27.6 mV/decade. Our compact and portable yarn-based SUX sensors achieved 94.1% recovery at low concentrations, demonstrating feasibility in real-world applications. While other challenges remain, the development of a thread-based ion-selective electrode for SUX detection shows that it is possible to detect this poison in urine and paves the way for other low-cost, rapid forensic diagnostic devices.

Butyryl-cholinesterase deficiency: A case report of delayed recovery after general anaesthesia

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Suggestive presentation of foreign body aspiration needs emergency bronchoscopy.

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Meticulous history and high index of suspicion is needed to diagnose butyryl-cholinesterase deficiency.

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Succinylcholine apnoea is treated by ventilation and recombinant enzyme could be the specific antidote.

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Genetic testing is needed to confirm the diagnosis of butyryl-cholinesterase deficiency.

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Succinylcholine apnoea patient and their family should be well-informed about the situation.

Background

Apnoea and prolonged paralysis after succinylcholine administration is not uncommon occurrence in anaesthetic practice. It occurs due to inherited or acquired deficiency of butyrylcholinesterase.

Case report

Here we report a case of succinylcholine apnoea for 2 h in a 5 years old girl who was anaesthetized for bronchoscopic extraction of a foreign body. She was subsequently kept on assisted ventilation. She recovered few minutes after I.V. atropine and naloxone. Laboratory investigation revealed low cholinesterase activity. Thus the girl was given 150 mL fresh frozen plasma. She has been discharged the next day after complete recovery.

Conclusion

As the genetic analysis was not available to confirm the diagnosis of atypical variant of cholinesterase. The family was advised to submit serum samples for assessment of cholinesterase activity and avoid exposure to cholinesterase inhibitors. Moreover, clear instructions were given to the family so they can warn the anaesthetists in case any family member undergoes general anesthesia for any reason in the future. Furthermore, they must be strongly advised to avoid exposure to anticholinesterases as they might have heightened sensitivity to these agents. It should be emphasized that Naloxone and atropine could help speed up recovery in such cases.

Is There Still a Role for Succinylcholine in Contemporary Clinical Practice?

Succinylcholine is a depolarizing muscle relaxant that has been used for rapid sequence induction and for procedures requiring only a brief duration of muscle relaxation since the late 1950s. The drug, however, has serious side effects and a significant number of contraindications. With the recent introduction of sugammadex in the United States, a drug that can rapidly reverse even large amounts of rocuronium, succinylcholine should no longer be used for endotracheal intubation and its use should be limited to treating acute laryngospasm during episodes of airway obstruction. Given the numerous risks with this drug, and the excellent ablation of airway reflexes with dexmedetomidine, propofol, lidocaine and the larger amounts of rocuronium that can now be administered even for an anesthesia of short duration. The use of succinylcholine for endotracheal intubation should disappear from clinical practice.