Sux. apnea
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Reaction time in minutes Pseudocholinesterase activity
< 5 above normal
5 - 20 normal
20 - 30 borderline low
> 30 below normal
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105
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Drugs - Benzodiazepine premedication
- Opioid overdose intra-operatively
- Insufficient reversal of nondepolarising muscle relaxants
- Suxamethonium
- Failure to discontinue anaesthetic vapour
-Pre-operative alcohol intoxicationEndocrine - Severe hypothyroidism
- Hypoglycaemia
- Diabetic keto-acidosis (DKA), hyper osmotic nonketotic coma (HONK)
- Addison’s crisisElectrolyte disturbances
- Hyponatraemia
- Hypocalcaemia
- Hypermagnesaemia (magnesium sulphate treatment etc)
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Acid-base disturbances
- Hypercapnoea (“Carbon dioxide narcosis”) – due to hypoventilation
- Hypocapnoea (no drive for breathing) – due to hyperventilation
Hypothermia
Intra-operative complications - Cerebro-vascular incident
- Myocardial infarctionUndiagnosed muscle diseases
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Treat apnoea - Mechanical ventilation until normal muscle strength returns- peripheral nerve stimulator to distinguish between central
depression and neuromuscular block Prevent awareness - Continue anaesthesia with inhalant or sedate well with
benzodiazepines
Exclude differential diagnosis
- Drugs, Endocrine, Electrolyte disturbances, Acid-base disturbances,Hypothermia, Intra-operative complications, Undiagnosed muscle diseases
Fresh frozen plasma/whole blood
- Contains Pseudo-cholinesterase will speed recovery
Recombinant Pseudo-cholinesterase
- Very expensive. # Cheaper to treat symptomatically
Confirm scoline apnoea - Pseudo-cholinesterase activity- dibucaine or fluoride number
If scoline apnoea confirmed - Council patient family members- Medic alert bracelet for patient- Test family members
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