An Oral Clinician?s Perspective towards Peutz Jegher?s Syndrome ? A Case Report

Abstract

Pseudocholinesterase (PChE) is a significant drug metabolizing enzyme of succinylcholine, mivacurium, choloroprocain and diamorphine, which is used as a diagnostic and therapeutic parameter in organophosphate toxicity. PChE activity may decrease following hepatic and renal failure, malnutrition, malignancy, burns and toxic inhibition or due to inherited enzyme variants. Most studies which have examined the relationship between ageing and oxidative enzymes of drug metabolism have been consistent in finding no effect of ageing. In our study, we planned to investigate age and gender related influences on PChE activity in a surgical population. We measured the level of PChE preoperatively in 492 patients excluding those who were pregnant, had solid organ failure or malignancies or who were taking drugs known to induce or inhibit enzyme activity. The mean enzyme level was found to be significantly higher in males than in their female counterparts. While the enzyme levels of males decreased significantly in those over 60 years of age, the minimum mean enzyme levels in females was in the 18-44 age group. The PChE activity decreased to a minimum level in the elderly men and the mature prolific women of the surgical population. Our findings suggest that the risk of 'prolonged apnea' is likely to increase in these age groups when anesthetic drugs which are metabolized by PChE are used.