Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
DR B Sharath Chandra KumarPost GraduateMD AnaesthesiologyCHALMEDA ANAND RAO INSTITUTE OF MEDICAL SCIENCESKarimnagar, INDIA...
INTRODUCTION Also known as scoline apnoea or post anaestheticapnoea Abnormal prolongation of action of succinyl choline,...
Succinylcholine Depolarizing muscle relaxant Rapid action, 30-60 sec Quick metabolism, 3-5 min Metabolized by plasma c...
Causes of Succinyl-choline apnea1. Low or atypical Plasma Cholinesterase Level2. Altered Response of the End-Plate to Depo...
Atypical pseudo cholineterase Naturally occurring mutation Leu307Pro of humanbutyrylcholinesterase Produces Atypical pse...
Atypical pseudo cholineterase andvysyas Incidence of Atypical pseudo cholineterase was foundmore in arya vysya community...
Notable people from arya vysyaMAHATMA GANDHI – our father of nationPOTTI SREERAMULU – sacrifised life forformation of our ...
How to identify pre operatively?1. Simple blood test using ACHOLEST Test Paper :- When a drop of the patients plasma is ap...
ACHOLEST TEST PAPER INFERENCEReaction time in minutes Pseudocholinesterase activity< 5 above normal5 - 20 normal20 - 30 bo...
2. Dibucaine number :- an amide local anaesthetic- inhibits normal pseudocholinesrerase by 80 %& atypical one with only ap...
Prevention Good history regarding vysya status & previousprolongation Estimation of pseudocholinesterase Qualitatively &...
Treatment1. Fresh Plasma transfusion from non deficient person2. Continue controlled ventilation till full recovery3. Reco...
My experiences1. A 20 year old engineering student posted for an ENTsurgery.- PAC done. ASA grade 1, VYSYA, MPG 2- on the ...
2. a 35 year male patient posted for upper limb orthosurgery- PAC done on the day before- ASA 1, MPG 1, VYSYA- brachial pl...
Bibilography1. Bush, G. H., Prolonged apnea due to suxamethonium.Brit..1. Anae8th. 33,454(1961).2. Harris, H., Whittaker, ...
Thanks
Succinyl choline apnea sharath
Upcoming SlideShare
Loading in …5
×

Succinyl choline apnea sharath

regarding etiology, patho physiology, relation with vysya community, prevention & management

  • Be the first to comment

Succinyl choline apnea sharath

  1. 1. DR B Sharath Chandra KumarPost GraduateMD AnaesthesiologyCHALMEDA ANAND RAO INSTITUTE OF MEDICAL SCIENCESKarimnagar, INDIAGuide : DR B Syama Sundara Rao, Prof
  2. 2. INTRODUCTION Also known as scoline apnoea or post anaestheticapnoea Abnormal prolongation of action of succinyl choline,due to failure of the body to metabolise it; leading tosustained paralysis
  3. 3. Succinylcholine Depolarizing muscle relaxant Rapid action, 30-60 sec Quick metabolism, 3-5 min Metabolized by plasma cholinesterase, also known aspseudocholinesterase or butyryl cholinesterase orBuChE
  4. 4. Causes of Succinyl-choline apnea1. Low or atypical Plasma Cholinesterase Level2. Altered Response of the End-Plate to DepolarizingRelaxants; myasthenia gravis3. Accumulation of Succinylmonocholine after a doseof 5-7 mg/kg body weight, which is slowlymetabolized than succinylcholine4. Central Depression From Succinylcholine5. Failure of Redistribution of Succinylcholine from theEnd-Plate6. Hepatic failure, pregnancy
  5. 5. Atypical pseudo cholineterase Naturally occurring mutation Leu307Pro of humanbutyrylcholinesterase Produces Atypical pseudo cholineterase Wont metabolize succinylcholine Succinylcholine apnoea
  6. 6. Atypical pseudo cholineterase andvysyas Incidence of Atypical pseudo cholineterase was foundmore in arya vysya community Arya vaishya or arya vysya is an orthodox telugu/kannada speaking indians Found in Andhra Pradesh, Karnataka, Tamil Nadu,Maharashtra and Orissa
  7. 7. Notable people from arya vysyaMAHATMA GANDHI – our father of nationPOTTI SREERAMULU – sacrifised life forformation of our state andhra pradeshKONIJETI ROSAIAH – ex CM of AP& present governor of tamilnadu
  8. 8. How to identify pre operatively?1. Simple blood test using ACHOLEST Test Paper :- When a drop of the patients plasma is applied tothe substrate-impregnated test paper, a colorimetricreaction occurs. The time it takes the exposedAcholest Test Paper to turn from green to yellow isinversely proportional to the pseudocholinesteraseenzyme activity in the plasma sample
  9. 9. ACHOLEST TEST PAPER INFERENCEReaction time in minutes Pseudocholinesterase activity< 5 above normal5 - 20 normal20 - 30 borderline low> 30 below normal
  10. 10. 2. Dibucaine number :- an amide local anaesthetic- inhibits normal pseudocholinesrerase by 80 %& atypical one with only approx 20 %- Dibucaine number 80 indicates normalenzyme, homozygous atypical variant has Dibucainenumber 20
  11. 11. Prevention Good history regarding vysya status & previousprolongation Estimation of pseudocholinesterase Qualitatively &Quantatively Rule out other systemic diseases like hepaticdysfunction Avoid repeated & large doses of succinylcholine
  12. 12. Treatment1. Fresh Plasma transfusion from non deficient person2. Continue controlled ventilation till full recovery3. Recombinant pseudocholinesterase administrarion4. Not much role of anti cholinesterases
  13. 13. My experiences1. A 20 year old engineering student posted for an ENTsurgery.- PAC done. ASA grade 1, VYSYA, MPG 2- on the day of surgery, junior resident failed to informthat he is a vysya- as usual we gave propofol & succinylcholine- patient did’nt recover even after 15 min- to our horror, we came to know that he was a vysya- that patient recovered 6 hours after electiveventilation- a great relief to whole of our department
  14. 14. 2. a 35 year male patient posted for upper limb orthosurgery- PAC done on the day before- ASA 1, MPG 1, VYSYA- brachial plexus block was given through interscalene approach using winnie technique- surgery started & patient was in discomfort due tosparing- immediately converted to GA using propofol &scoline- again same horror- but to our goodness he recovered in 45 min. all ofus had a sigh….
  15. 15. Bibilography1. Bush, G. H., Prolonged apnea due to suxamethonium.Brit..1. Anae8th. 33,454(1961).2. Harris, H., Whittaker, M., Lehmann, H., and Silk, E.,The pseudocholinesterase variants. Esterase levels anddibucaine numbers in families selected throughsuxamethonium sensitive individuals. Acta Genet.Statist. Med. 10, 1 (1960).3. Stoelting physio pharma4. Millers
  16. 16. Thanks

    Be the first to comment

    Login to see the comments

  • ChandrakantKshirsagar

    Aug. 8, 2016
  • ssuser0405f5

    Oct. 29, 2016
  • ibrahimkhan141

    Dec. 20, 2016
  • a7med7illi

    Feb. 10, 2017
  • ibra2

    Mar. 6, 2017
  • drasunil

    May. 11, 2017
  • BhargavVishnu3

    Sep. 5, 2017
  • Archanag8

    Dec. 7, 2017
  • AshishGupta1208

    Jan. 7, 2018
  • Bhawanakomal

    Apr. 21, 2018
  • HemantKompalwar1

    May. 7, 2018
  • ThabangPhasha1

    Sep. 27, 2018
  • prasanthvnair

    Oct. 24, 2018
  • ViniithaBaskaran

    Oct. 31, 2018
  • arwaalabbasi1

    Dec. 30, 2018
  • RouhiKauser

    Jan. 10, 2019
  • DrakshiGoel

    Jan. 16, 2019
  • KarthikrajaShrishti

    May. 14, 2019
  • MS0876

    May. 20, 2019
  • awwannabagewadi

    Jul. 25, 2019

regarding etiology, patho physiology, relation with vysya community, prevention & management

Views

Total views

10,559

On Slideshare

0

From embeds

0

Number of embeds

9

Actions

Downloads

308

Shares

0

Comments

0

Likes

25

×