Severe pseudocholinesterase deficiency and ECT: A case report

Abstract

Pseudocholinesterase (PCE) deficiency is an inherited condition in which recovery from anesthetic agents like succinylcholine and mivacurium is slow and complicated by prolonged paralysis of respiratory muscles in susceptible patients. We present a very rare case of a 29-year-old woman with a 15-year history of schizophrenia with pseudocholinesterase deficiency that we encountered in our practice. Since the measurement of PCE levels of all patients eligible for ECT is part of our pre-ECT assessment procedure, we could detect the deficiency before the ECT procedure. We performed modified ECT with propofol and rocuronium instead of succinylcholine as usual. Sugammadex was used for speeding up the recovery. Response to treatment as measured by the Positive and Negative Symptom Scale was good and we completed 9 ECT sessions without complication. We suggest further investigation of this topic because screening for PCE levels in pre-ECT assessment may reduce complications of modified ECT with anesthesia.