Quantitative Neuromuscular Monitoring Permits Early Diagnosis of Abnormal Butyrylcholinestrase: Two Case Studies Demonstrating Prevention of Awareness from Premature Awakening-Quantitative Neuromuscular Monitoring Permits Early Diagnosis of Abnormal Butyrylcholinestrase: Two Case Studies Demonstrating Prevention of Awareness from Premature Awakening

Quantitative Neuromuscular Monitoring Permits Early Diagnosis of Abnormal Butyrylcholinestrase: Two Case Studies Demonstrating Prevention of Awareness from Premature Awakening

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The April 2024 issue of the AANA Journal features a critical study on the significance of quantitative neuromuscular monitoring (NMM) during anesthesia for patients with butyrylcholinesterase (BChE) deficiency. The study presents two case reports that highlight how NMM can help prevent premature awakening from anesthesia linked with succinylcholine-induced neuromuscular block (NMB).<br /><br />In Case 1, a pregnant woman experienced a delay in respiratory recovery post-surgery due to unknown abnormal BChE. Without initial NMM, she experienced awareness during paralysis but was successfully managed and avoided intensive care unit admission once quantitative NMM was employed. Serum tests confirmed her abnormal BChE.<br /><br />Case 2 involved a 49-year-old woman with a complex medical history, where NMM was proactively used. This early monitoring allowed the care team to manage her recovery accurately and prevented premature emergence, even noting drug interactions between succinylcholine and clindamycin.<br /><br />The report underscores the risk of using succinylcholine without quantitative NMM, especially in patients with BChE deficiency, as this can lead to prolonged paralysis and the risk of anesthesia awareness. The article cites broader evidence and studies showing that residual neuromuscular blockade can cause respiratory complications and the difficulty in detecting adequate recovery through traditional qualitative monitoring alone.<br /><br />Authors advocate for the routine application of quantitative NMM in all cases involving neuromuscular agents, to mitigate risks of unplanned extubation, awareness, and potential respiratory complications. The study concludes with a call for increased vigilance and standardized practices integrating NMM into anesthesia procedures.

Keywords

quantitative neuromuscular monitoring

butyrylcholinesterase deficiency

anesthesia

succinylcholine

neuromuscular block

anesthesia awareness

respiratory complications

case reports

NMM

AANA Journal