Abnormal reaction to procaine and succinylcholine in a patient with inherited atypical plasma cholinesterase: case report

Abstract

Prolonged postoperative apnoea has been reported to occur frequently after the intravenous injection of succinylcholine in patients possessing atypical plasma cholinesterase. Reduced hydrolysis rates of ester-type local anaesthetics were also found to be associated with this condition. This is the first documented case in which the same patient developed prolonged apnoea after the use of succinylholine and peripheral cardiovascular collapse after the use of procaine for dental surgery on two other occasions. Determination of plasma cholinesterase activity and the dibucaine number revealed that the patient possessed an atypical homozygous plasma cholinesterase. Of the available four relatives of the patient, three proved to be atypical-normal heterozygotes and one a normal homozygote. One of the relatives, a heterozygote, developed severe systemic toxic reactions after the administration of procaine for pudendal nerve block. The presence of atypical plasma cholinesterase may explain some of the unclarified "anaphylactic" reactions to local anaesthetics in patients. © 1968 Canadian Anesthesiologists.