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Plasma cholinesterase studies in some pathological conditions in man

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Summary and conclusions

A review of pathological conditions and of specifie drugs which may affect plasma cholinesterase in man has been made. Short of experimental D.F.P. injections, there appear to be very few instances where reduction of plasma cholinesterase would bring it to such low values as to become a contra-indication to the use of succinylcholine. However, cases of severe hepatic damage and cachectic states exhibit the lowest plasma cholinesterase levels and, for that reason, it would seem advisable to exercise extreme care in the use of this relaxant.

Three cases of prolonged apnoea following infusion of succinylcholine have been reported, none of them exhibiting any deviation from normal plasma, cholinesterase levels.

Résumé

Les auteurs font allusion au rôle de la cholmestérase cellulaire par contraste avec la cholinestérase plasmatique ou pseudo-cholinestérase. Pour l’estimation de cette dernière, ils ont fait appel, entre autres, à la méthode électrométrique de Michel, basée sur la diminution de pH résultant de l’acide acétique libéré à l’occasion de l’hydrolyse de l’acétylcholme par la pseudo-cholinestérase.

Les valeurs normales, basées sur cette méthode, se chiffreraient de 0.62 à 1 26 unités.

Les estimés ont été faits en vue d’apprécier d’une part le rôle joué par la pseudo-cholinestérase dans l’hydrolyse de la succmylcholine employée comme adjuvant en anesthésie, et de déterminer d’autre part l’influence que peuvent exercer certains états pathologiques ou certains agents chimiques et médicamenteux sur le taux dé pseudo-cholinestérase et, indirectement, sur l’intensité d’action de la succinylcholine aux doses cliniquement employées.

Le niveau de la pseudo-chohnestérase a été trouvé abaissé dans certains états pathologiques tels que l’insuffisance hépatique, l’empoisonnement par insecticides, la malnutrition, l’état post-opératoire, la schizophrénie, les anémies, etc... et à la suite de l’emploi de substances médicamenteuses telles que prostigmine et physostigmine, vitamine B-l, etc....

Les états s’accompagnant d’une baisse de pseudo-cholinestérase offrent-ils une sensibilité plus marquée à l’action de la succinylcholme? De l’opinion des auteurs, cette sensibilité, bien que présente, ne ferai pas la règle et une curarisation prolongée secondaire à l’emploi de succinylcholme serait plus spécifiquement imputable à une rétention de gaz carbonique Un taux bas de pseudo-cholinestérase n’exclut donc pas l’emploi de succinylcholme, mais engage simplement à une plus grande prudence

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Correspondence to W. A. Wielhorski or M. Dubeau or P. Riopel.

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Wielhorski, W.A., Dubeau, M. & Riopel, P. Plasma cholinesterase studies in some pathological conditions in man. Can. Anaes. Soc. J. 3, 31 (1956). https://doi.org/10.1007/BF03016740

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Keywords

  • Succinylcholine
  • Physostigmine
  • Cholinesterase Activity
  • Rase
  • Plasma Cholinesterase