Article, Early Access,
Prolonged duration of action of suxamethonium in pregnant and postpartum patients: A registry study
Affiliations
- [1] Copenhagen Univ Hosp, Ctr Head & Orthopaed, Dept Anaesthesia, Rigshosp, Inge Lehmanns Vej 6,Sect 6011, DK-2100 Copenhagen, Denmark [NORA names: KU University of Copenhagen; University; Denmark; Europe, EU; Nordic; OECD];
- [2] Copenhagen Univ Hosp, Ctr Head & Orthopaed, Dept Anaesthesia, Rigshosp, Inge Lehmanns Vej 6,Sect 6011, DK-2100 Copenhagen, Denmark [NORA names: Capital Region of Denmark; Hospital; Denmark; Europe, EU; Nordic; OECD];
- [3] Holbaek Cent Hosp, Dept Anaesthesia, Holbaek, Denmark [NORA names: Region Zealand; Hospital; Denmark; Europe, EU; Nordic; OECD];
- [4] Danish Air Ambulance, Aarhus, Denmark [NORA names: Other Hospitals; Hospital; Denmark; Europe, EU; Nordic; OECD];
- [5] Herlev Hosp, Dept Anaesthesia, Danish Cholinesterase Res Unit, Herlev, Denmark [NORA names: Capital Region of Denmark; Hospital; Denmark; Europe, EU; Nordic; OECD];
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Abstract
BackgroundSuxamethonium is hydrolysed by butyrylcholinesterase (BChE) and a low BChE activity can result in a prolonged duration of action of suxamethonium. The BChE activity is reduced during pregnancy and postpartum period by up to 33%. However, it can also be reduced by mutations in the BChE gene. In this study, we assessed BChE activity and mutations in the BChE gene in pregnant and postpartum patients with prolonged duration of action of suxamethonium. It was hypothesised that at least 30% of patients with a low BChE activity did not have a mutation in the BChE gene.MethodsIn this registry study we focused on pregnant and postpartum patients with a history of prolonged duration of action of suxamethonium referred to the Danish Cholinesterase Research Unit (DCRU) between March 2007 and January 2023. Primary outcome was the proportion of patients without a mutation among patients with a low BChE activity. Secondary outcomes were the proportion of patients with a low BChE activity and the proportion of patients with a mutation out of the total number of patients.ResultsA total of 40 patients were included and among patients with a low BChE activity, 6% (95% CI: 1%-21%) did not have a mutation. Out of the total number of included patients referred to the DCRU, 90% (95% CI: 76%-97%) had a mutation and 94% (95% CI: 80%-99%) had a low BChE activity.ConclusionAmong pregnant and postpartum patients with a history of prolonged duration of action of suxamethonium and a low BChE activity, 6% did not have a mutation in the BChE gene. Our findings suggest that during pregnancy and postpartum clinically relevant prolonged duration of action of suxamethonium rarely occurs in genotypically normal patients.ConclusionAmong pregnant and postpartum patients with a history of prolonged duration of action of suxamethonium and a low BChE activity, 6% did not have a mutation in the BChE gene. Our findings suggest that during pregnancy and postpartum clinically relevant prolonged duration of action of suxamethonium rarely occurs in genotypically normal patients.