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Kozlova DI, Khizha VV, Anosova LV, Korolkova AA, Vasilev DS, Rybakov AV, Pakhomov KV, Shishkin AB, Sumina SV, Ballyzek MF. A New Diagnostic Index Based on the Activity of Butyrylcholinesterase Isoforms for Laboratory Confirmation of Mild Cognitive Impairment Diagnosis. J EVOL BIOCHEM PHYS+ 2022. [DOI: 10.1134/s002209302203022x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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2
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Robles A, Michael M, McCallum R. Pseudocholinesterase Deficiency: What the Proceduralist Needs to Know. Am J Med Sci 2019; 357:263-267. [DOI: 10.1016/j.amjms.2018.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/02/2018] [Accepted: 11/05/2018] [Indexed: 12/20/2022]
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LaRocca CJ, Beilman GJ, Birch M. A Case of Pseudocholinesterase Deficiency Resulting From Malnutrition. ACTA ACUST UNITED AC 2016; 7:112-4. [PMID: 27467903 DOI: 10.1213/xaa.0000000000000362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pseudocholinesterase deficiencies occur because of both genetic and acquired factors. We present the case of a patient with a history of bariatric surgery and severe malnutrition who subsequently developed prolonged neuromuscular blockade after succinylcholine administration. She had markedly decreased pseudocholinesterase levels at the time of the incident, but her motor function returned to normal with supportive care. After aggressive nutritional support over multiple weeks, her pseudocholinesterase levels drastically improved. For those patients in a poor nutritional state who experience an unexpected episode of apnea or prolonged neuromuscular blockade, practitioners must always consider malnutrition-induced pseudocholinesterase deficiency as a possible etiology.
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Affiliation(s)
- Christopher J LaRocca
- From the Departments of *Surgery and †Anesthesiology, University of Minnesota, Minneapolis, Minnesota
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Watson A, Opresko D, Young R, Hauschild V. Development and application of acute exposure guideline levels (AEGLs) for chemical warfare nerve and sulfur mustard agents. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2006; 9:173-263. [PMID: 16621779 DOI: 10.1080/15287390500194441] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Acute exposure guideline levels (AEGLs) have been developed for the chemical warfare agents GB, GA, GD, GF, VX, and sulfur mustard. These AEGLs were approved by the National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances after Federal Register publication and comment, and judged as scientifically valid by the National Research Council Committee on Toxicology Subcommittee on AEGLs. AEGLs represent general public exposure limits for durations ranging from 10 min to 8 h, and for three levels of severity (AEGL-1, AEGL-2, AEGL-3). Mild effects are possible at concentrations greater than AEGL-1, while life-threatening effects are expected at concentrations greater than AEGL-3. AEGLs can be applied to various civilian and national defense purposes, including evacuation and shelter-in-place protocols, reentry levels, protective clothing specifications, and analytical monitoring requirements. This report documents development and derivation of AEGL values for six key chemical warfare agents, and makes recommendations for their application to various potential exposure scenarios.
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Affiliation(s)
- Annetta Watson
- Toxicology and Hazard Assessment Group, Life Sciences Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830-6480, USA.
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Morera Ocón FJ, Ripoll Orts F, Martín Arévalo J, Checa Ayet F. Colinesterasa plasmática como indicador de gravedad en procesos agudos. Med Clin (Barc) 2005; 124:435. [PMID: 15799854 DOI: 10.1157/13072847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Cerf C, Mesguish M, Gabriel I, Amselem S, Duvaldestin P. Screening patients with prolonged neuromuscular blockade after succinylcholine and mivacurium. Anesth Analg 2002; 94:461-6, table of contents. [PMID: 11812719 DOI: 10.1097/00000539-200202000-00044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED Patients with pseudocholinesterase (BChE) variants may exhibit markedly prolonged paralysis after the administration of succinylcholine or mivacurium. We sought to evaluate to what extent molecular biology may contribute to the biological assessment of such patients. We conducted a prospective cohort study in patients referred to our center between 1995 and 1999 for prolonged neuromuscular blockade after mivacurium or succinylcholine. For each patient, phenotyping was performed with a conventional biochemical technique and molecular biology for the detection of the atypical mutation (A variant). Among the 36 patients referred, 31 had low BChE activity, 26 had received mivacurium (BChE activity, 2.1 U/mL; 0.3-4.3 U/mL), and 5 had received succinylcholine (BChE activity, 1.9 U/mL; 1.1-3.2 U/mL) (mean; extreme values). The mean clinical duration of paralysis was 90 min (40-140 min) after succinylcholine and 301 min (120-720 min) after mivacurium. Thirty-two patients had a BChE deficiency of genetic origin: 20 were homozygous (AA), 10 were heterozygous (UA) for the A variant, and 2 did not have the A mutation (UU). One heterozygous UA patient had normal BChE activity. Nine among the heterozygous UA and the two homozygous UU patients probably carried a not-screened variant. In most cases, biochemical diagnosis was sufficient to confirm the existence of constitutional deficiency; molecular biology improved the accuracy of diagnosis in 11 patients (30%) but had few or no clinical implications for the patient him- or herself. IMPLICATIONS Systematic screening for the pseudocholinesterase atypical variant by biochemical and DNA analysis after a prolonged neuromuscular blocking effect of succinylcholine or mivacurium shows that molecular biology could improve the diagnosis in approximately one third of patients, but with few clinical implications, compared with biochemical testing.
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Affiliation(s)
- Charles Cerf
- Department of Anesthesia and Intensive Care Unit, Henri Mondor Hospital, AP-HP, Créteil, France
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Cerf C, Mesguish M, Gabriel I, Amselem S, Duvaldestin P. Screening Patients with Prolonged Neuromuscular Blockade After Succinylcholine and Mivacurium. Anesth Analg 2002. [DOI: 10.1213/00000539-200202000-00044] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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8
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Imerman B, Caruso LJ, Zori RT. Prolonged neuromuscular block in a patient undergoing renal transplantation. J Clin Anesth 2001; 13:540-4. [PMID: 11704454 DOI: 10.1016/s0952-8180(01)00321-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Prolonged neuromuscular block is an anesthetic complication that every anesthesiologist should understand. This article presents a case of prolonged neuromuscular block in a renal transplant patient that was likely due to pseudocholinesterase deficiency. The different types of pseudocholinesterase deficiency and their clinical implications are reviewed. Also discussed are the workup and other causes for prolonged neuromuscular blockade.
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Affiliation(s)
- B Imerman
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610-0254, USA
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Lejus C, Blanloeil Y, Burnat P, Souron R. [Cholinesterases]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1998; 17:1122-35. [PMID: 9835982 DOI: 10.1016/s0750-7658(00)80006-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To review current data on butyrylcholinesterase. DATA SOURCES Search through Medline data bases of articles in French or English. STUDY SELECTION Original articles and case reports were selected. Letters to editor were excluded. DATA EXTRACTION The articles were analyzed in order to obtain current data on biochemical structure, action, major pathological variations, especially with regard to the recent informations obtained by molecular biology concerning the identification of genetic variants. DATA SYNTHESIS Butyrylcholinesterase must be differentiated from acetylcholinesterase, which cannot hydrolyse succinylcholine. The physiological action of butyrylcholinesterase remains unknown, although it can hydrolyse many drugs. Excluding genetical mutations, several physiopathological situations alter butyryl-cholinesterase activity. Butyrylcholinesterase activity assessment does not allow the diagnosis of genetic variants. Whatever the origin, only deficits of more than 50% modify significantly the metabolism of succinylcholine or mivacurium. The diagnosis of a prolonged neuromuscular blockade is obtained with systematic monitoring of the neuromuscular function in case of administration of mivacurium or succinylcholine. Mivacurium should only be re-injected when one response at train of four is obtained. In case of prolonged neuromuscular blockade, the anticholinesterasic agent should not be administered when no response at train of four is obtained. The biochemical methods using inhibitors (dibucaine, fluoride) of the butyrylcholinesterase and a familial study lead to the diagnosis in most cases because the atypical and fluoride variants are the most frequent. When results are doubtful, genetic molecular methods with the use of PCR and restriction enzymes allow a rapid diagnosis.
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Affiliation(s)
- C Lejus
- Service d'anesthésie-réanimation chirurgicale, CHR, Nantes, France
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Opresko DM, Young RA, Faust RA, Talmage SS, Watson AP, Ross RH, Davidson KA, King J. Chemical warfare agents: estimating oral reference doses. REVIEWS OF ENVIRONMENTAL CONTAMINATION AND TOXICOLOGY 1998; 156:1-183. [PMID: 9597943 DOI: 10.1007/978-1-4612-1722-0_1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Health risk assessments for sites contaminated with chemical warfare agents require a comparison of the potential levels of exposure with a characterization of the toxic potency of each chemical. For noncancer health effects, toxic potency is expressed in terms of Reference Doses (RfD). A RfD is a daily exposure level or dose (usually expressed in units of milligrams of chemical per kilogram body weight per day) for the human population, including sensitive subpopulations, that is likely to be without an appreciable risk of deleterious effects. A daily exposure at or below the RfD is not likely to be associated with health risks, but as the amount of chemical that an individual is exposed to increases above the RfD, the probability that an adverse effect will occur also increases. A RfD is derived by first examining the available human or animal toxicity data to identify a dose or exposure that corresponds to a no-observed-adverse-effect level (NOAEL) or a lowest-observed-adverse-effect level (LOAEL). The NOAEL is the exposure level at which there are no statistically or biologically significant increases in frequency or severity of adverse effects between the exposed population and its appropriate control. Effects may be produced at this level, but they are not considered to be adverse if they do not result in functional impairment or pathological lesions that affect the performance of the whole organism or which reduce an organism's ability to cope with additional challenge. The LOAEL is the lowest exposure level at which there are statistically or biologically significant increases in frequency or severity of adverse effects between the exposed population and its appropriate control. If only a LOAEL is identified by the toxicity data, a NOAEL is estimated by dividing the LOAEL by a factor no greater than 10. This extrapolation factor of 10 or less is termed the LOAEL-to-NOAEL Uncertainty Factor (UFL). The NOAEL is also adjusted by the application of other Uncertainty Factors, including (1) a UFH < or = 10 to ensure that the resulting RfD protects segments of the human population that may be more sensitive to the chemical than the average person; (2) a UFA < or = 10 to extrapolate from the experimental animal species to humans; (3) a UFS < or = 10 to extrapolate from an experimental subchronic exposure study to a potential chronic exposure; and (4) a UFD < or = 10 to ensure that the resulting RfD is protective for all possible adverse effects, particularly those that may not have been adequately evaluated in the available studies. A Modifying Factor (MF), based on a qualitative professional assessment of the data, may also be used to account for other factors (e.g., deficiencies in the critical study) that are not adequately covered by the standard Uncertainty Factors. 1. Agent HD (Sulfur Mustard). RfDe = 7 x 10(-6) mg kg-1 d-1. A LOAEL was identified in a two-generation reproductive toxicity study conducted in rats. A total uncertainty factor of 3000 was applied to account for protection of sensitive subpopulations (10), animal-to-human extrapolation (10), LOAEL-to-NOAEL extrapolation (3), and extrapolation from a subchronic to chronic exposure (10). A LOAEL-to-NOAEL UF of 3, instead of the default value of 10, was used because the critical effect (stomach lesions) was considered to be "mild" in severity and may have been enhanced by the vehicle used (sesame oil in which sulfur mustard is fully soluble) and the route of administration (gavage), which is more likely to result in localized irritant effects. The key study did identify a toxic effect that is consistent with the vesicant properties of sulfur mustard. In none of the other available studies was there any indication of a different effect occurring at a lower exposure level.
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Affiliation(s)
- D M Opresko
- Life Sciences Division, Oak Ridge National Laboratory, TN 37831, USA
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11
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Jensen FS, Viby-Mogensen J. Plasma cholinesterase and abnormal reaction to succinylcholine: twenty years' experience with the Danish Cholinesterase Research Unit. Acta Anaesthesiol Scand 1995; 39:150-6. [PMID: 7793179 DOI: 10.1111/j.1399-6576.1995.tb04034.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
For more than 20 years, the Danish Cholinesterase Research Unit (DCRU) has collected information about patients showing an abnormal response to succinylcholine. The purpose of this study was, on the basis of the 20 years' experiences with the Unit, to evaluate our clinical findings in patients referred because of prolonged response following succinylcholine. Also, we wanted to evaluate the results of our prospective controlled studies of the effect of succinylcholine in patients with normal and abnormal plasma cholinesterase genotypes. An explanation for the apparent abnormal response to succinylcholine was found in 61.1% of the 1,247 patients referred to the Unit. Of the 1,247 patients, 28.5% were genotypically normal and 46.5% had an abnormal genotype. In the remaining 24.9% of the patients, the genotype could not be established. The time to sufficient recovery of neuromuscular function following succinylcholine 1.0-1.5 mg kg-1 was 15-30 min in patients heterozygous for one abnormal gene, 35-45 min in patients heterozygous for two abnormal genes and 90-180 min in patients homozygous for the atypical gene. Patients with two newly discovered genotypes (AK (5 patients) and AH (1 patient) showed slightly prolonged (20 min) and markedly prolonged (90 min) duration of action of succinylcholine, respectively. Our results indicate that it is a problem for many anaesthetists to correctly diagnose a prolonged response to succinylcholine. We therefore urge the anaesthetist always to use a peripheral nerve stimulator when faced with a case of apparent abnormal response to succinylcholine.
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Affiliation(s)
- F S Jensen
- Danish Cholinesterase Research Unit, Department of Anaesthesia, National University Hospital, Rigshospitalet, Denmark
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Kaplan RF, Garcia M, Hannallah RS. Mivacurium-induced neuromuscular blockade during sevoflurane and halothane anaesthesia in children. Can J Anaesth 1995; 42:16-20. [PMID: 7889579 DOI: 10.1007/bf03010565] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The neuromuscular blocking effects of mivacurium during sevoflurane or halothane anaesthesia was studied in 38 paediatric patients aged 1-12 yr. All received premedication with midazolam, 0.5 mg.kg-1 po and an inhalational induction with up to 3 MAC of either agent in 70% N2O and O2. The ulnar nerve was stimulated at the wrist by a train-of-four stimulus every ten seconds and the force of adduction of the thumb recorded with a Myotrace force transducer. Anaesthesia was maintained with a one MAC end-tidal equivalent of either volatile agent for five minutes before patients received mivacurium (0.2 mg.kg-1) iv. The onset of maximal blockade occurred in 2.4 +/- 1.26 (mean +/- SD) min with halothane and 1.8 +/- 0.54 min with sevoflurane (NS). Four patients failed to achieve 100% block (3 halothane, 1 sevoflurane). The times from injection to 5, 75, and 95% recovery during sevoflurane (9.8 +/- 2.6, 19.5 +/- 4.4, and 24.2 +/- 4.8 min) were greater than during halothane anaesthesia (7.2 +/- 2.2, 15.0 +/- 4.0, 19.2 +/- 4.9 min, respectively (P < 0.005). All patients demonstrated complete spontaneous recovery of neuromuscular function (T1 > 95%, T4/T1 > 75%) during the surgery which lasted 24-63 min. All patients showed clinical signs of full recovery of neuromuscular blockade (i.e., headlift, gag, or cough). Pharmacological reversal was not required. It is concluded that following a single intubating dose of mivacurium, the time to maximum relaxation was not different during halothane and sevoflurane anaesthesia; recovery times to 5, 75 and 95% twitch height were longer during sevoflurane anaesthesia and neuromuscular reversal was not necessary.
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Affiliation(s)
- R F Kaplan
- Department of Anesthesiology, Children's National Medical Center, Washington, DC 20010
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13
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Affiliation(s)
- A P Wheeler
- Division of Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tenn
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14
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Gill RS, O'Connell N, Scott RP. Reversal of prolonged suxamethonium apnoea with fresh frozen plasma in a 6-week-old infant. Anaesthesia 1991; 46:1036-8. [PMID: 1781528 DOI: 10.1111/j.1365-2044.1991.tb09917.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A period of apnoea lasting 480 minutes following suxamethonium in a 6-week-old male infant is described. Neuromuscular function recovered following the administration of fresh frozen plasma. The infant was found to be homozygous for atypical cholinesterase (E1a E1a). This is believed to be the youngest reported case of suxamethonium apnoea.
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Affiliation(s)
- R S Gill
- Department of Anaesthesia, Odstock Hospital, Salisbury, Wiltshire
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15
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Abstract
A case of one infant of twins who developed suxamethonium apnoea is described. Investigation of the family revealed him to be homozygous for atypical cholinesterase while the other twin was normal. Tissue HLA and blood typing indicated the twins to be identical.
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Affiliation(s)
- Y Mehta
- Department of Anaesthesia, Odense University Hospital, Denmark
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16
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Schoeffler P, Viallard JL, Monteillard C, Canis M, Gutknecht JL, Haberer JP. [Congenital anomaly of serum pseudocholinesterase originating in neonatal respiratory distress]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1984; 3:225-7. [PMID: 6742545 DOI: 10.1016/s0750-7658(84)80059-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Prolonged suxamethonium-induced apnoea was observed after obstetrical anaesthesia in a 30 year old woman with abnormal plasma cholinesterases (homozygous Ea1-Ea1). Flaccidity and apnoea in the child required controlled ventilation for 30 min. Possible mechanisms underlying prolonged apnoea after the use of suxamethonium for obstetrical anaesthesia are discussed. Atypical pseudocholinesterases were identified using quantitative dosage of enzymatic activity and inhibition of atypical pseudocholinesterases by dibucaine, fluoride, chloride, scoline and urea. This was carried out in the patient, her baby and family, thus identifying the genotype of the different family members.
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17
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Deam D, Emmanuel ER. A family with the silent cholinesterase gene. Anaesth Intensive Care 1983; 11:259-60. [PMID: 6604468 DOI: 10.1177/0310057x8301100316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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O'Ryan F, Epker BN. Prolonged apnea after orthognathic surgery due to atypical cholinesterase. INTERNATIONAL JOURNAL OF ORAL SURGERY 1981; 10:338-44. [PMID: 6807921 DOI: 10.1016/s0300-9785(81)80031-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Prolonged apnea (9 hours) after elective orthognathic surgery occurred in a healthy adult female. The patient had previously undergone multiple general anesthetics without any adverse reactions or complications. Measurement of the patient's serum postoperatively confirmed both a qualitative and quantitative defect in the cholinesterase enzyme. The genetic background for an atypical cholinesterase phenotype is briefly reviewed. Treatment modalities for this rare condition are also discussed.
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Brown SS, Kalow W, Pilz W, Whittaker M, Woronick CL. The plasma cholinesteerases: a new perspective. Adv Clin Chem 1981; 22:1-123. [PMID: 7027759 DOI: 10.1016/s0065-2423(08)60046-3] [Citation(s) in RCA: 107] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Abstract
Biochemical properties of plasma cholinesterase of significance to the anaesthetist are reviewed. The role of the genetic variants of the enzyme in suxamethonium sensitivity and hyperthermia are discussed with emphasis on the pregnant patient. Altered gene frequencies of the enzyme variants in some mental disorders is commented upon.
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Silk E, King J, Whittaker M. Scientific Review No. 5. Assay of cholinesterase in clinical chemistry. Ann Clin Biochem 1979; 16:57-75. [PMID: 37798 DOI: 10.1177/000456327901600114] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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McQueen MJ, Lepinskie F, Strickland RD, Trimble A. Abnormal enzyme phenotype (E1a E1f): normal response to succinylcholine. CANADIAN ANAESTHETISTS' SOCIETY JOURNAL 1979; 26:99-103. [PMID: 466558 DOI: 10.1007/bf03013777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The enzyme serum cholinesterase responsible for the hydrolysis of the muscle relaxant succinylcholine exists in the form of several variants. These may be identified in serum by using substances which inhibit their activity to different degrees. The heterozygote for the atypical and fluoride resistant enzymes (E1a E1f) is one of the phenotypes which has been reported to be sinsitive to succinylcholine. A case is described where succinylcholine given on two separate occasions did not induce apnoea in an individual phenotyped as E1a E1f by at least five methods of inhibition. This is the first reported example of such insensitivity to the drug in this phenotype. Temperature activities for the patient's serum over the range of 20 degrees C to 45 degrees C differed from that of an established E1a E1f phenotype used as a control. There was a progressive inactivation of the control serum at temperatures higher than 35 degrees C, as previously reported for this phenotype. Activity in the serum of the subject of this study did not exhibit the peak activity at 35 degrees C but continued to rise and probably reached a peak between 40 degrees C and 45 degrees C. The significance of these results in the context of current methods of phenotyping is discussed.
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Hanel HK, Viby-Mogensen J, de Muckadell OB. Serum cholinesterase variants in the Danish population. Acta Anaesthesiol Scand 1978; 22:505-7. [PMID: 696214 DOI: 10.1111/j.1399-6576.1978.tb01330.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A total of 1278 adult patients were screened for serum cholinesterase (E.C. 3.1.1.8) variants. The following were used for phenotyping of variants: dibucaine, fluoride, chloride, and urea. The observed incidence of cholinesterase variants in the Danish population was similar to that found in other European countries.
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Viby-Mogensen J, Hanel HK. Prolonged apnoea after suxamethonium: an analysis of the first 225 cases reported to the Danish Cholinesterase Research Unit. Acta Anaesthesiol Scand 1978; 22:371-80. [PMID: 726855 DOI: 10.1111/j.1399-6576.1978.tb01313.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
During the last 4 years, 225 patients have been referred to the Danish Cholinesterase Research Unit following an episode of prolonged apnoea after suxamethonium. Fourteen patients (6.2%) were found to have a low serum cholinesterase activity due to an acquired deficiency (for instance, liver disease, chronic debilitating disease or carcinoma). One hundred and forty-eight patients (65.8%) had an inherited abnormal serum cholinesterase, and 105 of these patients (46.7%) were homozygous for the atypical enzyme (E1 Ea1). The mean period of apnoea in this latter group was 92 min (range: 25--240). Seventeen patients (7.6%) were heterozygous for the normal and the atypical enzyme (Eu1 Ea1), with a mean apnoea period of 25 min (range: 7--60 min). Twelve patients were found to be heterozygous for the atypical and the silent gene (E(a)1 E(s)1). The mean period of apnoea was 126 min (range: 45--210 min). Fourteen patients had other rare genotypes. The longest mean period of apnoea (170 min, range: 70--330) was found in patients homozygous for the silent gene (Es1 Es1). The silent gene and the fluoride-resistant gene were found in 8.9% and 2.7% of the patients, respectively. In 63 patients (28.1%) both the type and quantity of serum cholinesterase were normal. In 34 of these patients (15.2%), the prolonged apnoea was due to other causes; for example, suxamethonium overdose, hyperventilation and central as well as peripheral respiratory depression. However, in the other 29 patients (12.9%), the reason for the prolonged apnoea could not be established. The possibility therefore exists that these cases represent unknown genotypes.
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Chan CS, Robinson JD, Lam KT. Prolonged apnoea due to suxamethonium in Chinese. Anaesth Intensive Care 1977; 5:260-2. [PMID: 900467 DOI: 10.1177/0310057x7700500315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A Chinese patient was hypersensitive to a therapeutic dose of suxamethonium because of a genetically determined quantitative and qualitative abnormality of plasma pseudocholinesterase.
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Abstract
The distribution of the plasma cholinesterase variants found in 1,374 mentally ill patients differs from that of a random control sample. The patients are more likely to have a rare phenotype than an individual from the normal population. None of the diagnostic groups have been shown to differ in the distribution of the E1a gene, but there is strong statistical evidence that Group IV (psychosis) patients have a higher frequency of the E1f gene than the other groups. The overall frequency of the electrophoretic variant C5 + did not differ significantly from that observed in a Caucasian population, with the exception of the increase observed in Group IV c2. Twenty-eight unrelated patients with Huntington's chorea were found to have a significantly altered incidence of the C5 + variant and six patients from this group were found to have the rare E1f gene. Our results indicate that the plasma cholinesterase variants may provide some insight into the inheritance of Huntington's chorea.
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27
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Shammas HF, Tabbara KF, der Kaloustian VM. Atypical serum cholinesterase in a family with congenital distichiasis. J Med Genet 1976; 13:514-5. [PMID: 1018310 PMCID: PMC1013481 DOI: 10.1136/jmg.13.6.514] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This paper describes the coexistence of genetically determined reduced cholinesterase activity and congenital distichiasis in the same family. The pedigree suggests that these two autosomal dominant diseases are segregated independently and do not show evidence of linkage.
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29
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Evans RT, Magill PJ. Evidence for mutation being the source of the abnormal gene for plasma cholinesterase. J Med Genet 1974; 11:117-20. [PMID: 4841080 PMCID: PMC1013104 DOI: 10.1136/jmg.11.2.117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Results of cholinesterase, dibucaine and fluoride numbers, and scoline hydrolysis rates are presented in a family found to have normal, silent and abnormal genes for plasma cholinesterase. Five sibs, confirmed by red cell grouping and tissue typing, have been shown to possess a cholinesterase pattern which cannot be explained on the basis of accepted theories of inheritance. In view of this it is suggested that, in this family, a mutation has occurred from a normal or silent gene to an abnormal gene.
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30
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Bonderman PW, Bonderman DP. Family segregating for multiple alleles of cholinesterase: a laboratory study. Clin Biochem 1973; 6:256-65. [PMID: 4777724 DOI: 10.1016/s0009-9120(73)80034-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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31
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Bevan DR. Suxamethonium Sensitivity: A Family Study. J ROY ARMY MED CORPS 1973. [DOI: 10.1136/jramc-119-02-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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32
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Gibb DB. Suxamethonium--a review. I. Physico-chemical properties and fate in the body. Anaesth Intensive Care 1972; 1:109-18. [PMID: 4668558 DOI: 10.1177/0310057x7200100202] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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33
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Walker IR, Zapf PW, Mackay IR. Cyclophosphamide, cholinesterase and anaesthesia. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1972; 2:247-51. [PMID: 4508246 DOI: 10.1111/j.1445-5994.1972.tb03069.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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34
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Becker CE. Serum cholinesterase activities and inhibition profiles of nonhuman primates. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 1972; 37:131-4. [PMID: 4625108 DOI: 10.1002/ajpa.1330370117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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35
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Wulfsohn NL. Succinylcholine dosage based on lean body mass. CANADIAN ANAESTHETISTS' SOCIETY JOURNAL 1972; 19:360-72. [PMID: 5042865 DOI: 10.1007/bf03005960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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36
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Fishtal A, Evans RT, Chapman CN. An original approach to the diagnosis of scoline-induced apnoea. J Clin Pathol 1972; 25:422-6. [PMID: 5046074 PMCID: PMC477338 DOI: 10.1136/jcp.25.5.422] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
A new technique is described for measuring the rate of scoline hydrolysis by plasma cholinesterase, which may prove useful in the diagnosis of scoline sensitivity. The importance of extensive family screening is emphasized and three cases possessing a silent gene are described.
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37
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Bonderman RP, Bonderman DP. Atypical and inhibited human serum pseudocholinesterase. A titrimetric method for differentiation. ARCHIVES OF ENVIRONMENTAL HEALTH 1971; 22:578-81. [PMID: 5550174 DOI: 10.1080/00039896.1971.10665904] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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38
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39
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Abstract
A study has been made of the temperature activity relationships of the serum cholinesterase variants differentiated by means of dibucaine and fluoride inhibition. Using benzoylcholine as substrate, there is a characteristic temperature activity curve for each phenotype, and, for those most sensitive to succinyldicholine, this differs radically from that of the normal enzyme.A true index of serum cholinesterase activity is obtained only at 37 degrees C, as at other temperatures various assumptions and correction factors have to be made, and the results could be misleading.
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