ABSTRACT s: case report of prolonged ventilation after scholine administration

METHODS : case study

RESULTS : case of acquired pseudocholine esterase

Case report: A 15 yr old boy h/o abdomen and vomiting diagnosed as a/c appendicitis and posted for open appendicectomyO/E:ASA 1ERegional anaesthesia provided with 3.4 5ml of SABSurgery was prolonged for more than 3 and half hours and patient started complaining of pain due to reduction in level of anaesthesia, administered injpentazocin (fortwin) 18mg+phenergan 12mgStill surgeon find difficult to close the abdomen due to lack of relaxation, we administered propofol 75mg+scholine 50mg,with mask ventilation and n2o :o2 50;50 ratio, surgery got over and even after 10 min as there is no spontaneous breathing patient was intubated and mechanically ventilated ,and send immediately pseudocholinesterase level 6 hrs later patient was extubated ,after clinically satisfying all the extubation criteria 6 hrs after extubation patient become restless, fasciculations, tachycardia and increased secretion, chest B/L creps +, power 3/51 unit fresh blood administered and fasciculation disappeared, all the investigation has been send before administering it12 hrs later again the fasciculation started with tachycardia, one more unit blood administered, scenario got completely settled there after patient got discharged 5 days afterBefore the discharge first send serum pseudocholine level came as low and diagnosed to beseudocholinesterase deficiency (congenital or acquired) Regular follow up for the patient for the next 6 months done, pseudocholine level send one time in b/w and level came as normal Case diagnosed as acquired pseudocholinesterase level with unknown cause