18. Reaction time in minutes Pseudocholinesterase activity
< 5 above normal
5 - 20 normal
20 - 30 borderline low
> 30 below normal

19. 105

22. Drugs - Benzodiazepine premedication
- Opioid overdose intra-operatively
- Insufficient reversal of nondepolarising muscle relaxants
- Suxamethonium
- Failure to discontinue anaesthetic vapour
-Pre-operative alcohol intoxication
Endocrine - Severe hypothyroidism
- Hypoglycaemia
- Diabetic keto-acidosis (DKA), hyper osmotic nonketotic coma (HONK)
- Addison’s crisis
Electrolyte
disturbances
- Hyponatraemia
- Hypocalcaemia
- Hypermagnesaemia (magnesium sulphate treatment etc)

23. 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 infarction
Undiagnosed
muscle diseases

25.  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