Pseudocholinesterase Deficiency in Ambulatory Surgery: A Case Report

TL;DR

A 53-year-old man was diagnosed with pseudocholinesterase deficiency after experiencing complications during surgery, requiring ICU care for safe recovery.

Contribution

This case highlights the importance of recognizing pseudocholinesterase deficiency in surgical patients.

Findings

The patient could not be extubated due to residual paralysis from PCHE deficiency.

Diagnosis occurred after surgical complications during a hernia repair.

The patient was successfully managed in the ICU and later extubated.

Abstract

Pseudocholinesterase (PCHE) deficiency is a rare condition that results in increased sensitivity to certain medications, including the paralytic agents succinylcholine and mivacurium. PCHE deficiency typically presents when patients cannot be weaned off the ventilator because of residual paralysis. These patients require mechanical ventilation and sedation until they are strong enough to be safely extubated. This report presents the case of a 53-year-old male patient whose only known surgical and anesthetic complication was post-op nausea and vomiting and who was diagnosed with PCHE deficiency after he could not be safely extubated in the operating room (OR) after a robotic inguinal hernia repair. The patient was admitted to the ICU and successfully extubated several hours later.