How important is the butyrylcholinesterase level for cesarean section?

- Succinylcholine, is used for rapid sequence induction of anesthesia for cesarean.
- Butyrylcholinesterase (BChE) hydrolyzes succinylcholine.
- If BChE levels change, residual neuromuscular block may occur.
- There is no data about BChE levels of high risk pregnancies in the literatüre.
- No difference of BChE levels found among healthy and high risk pregnancies.

ObjectivesButyrylcholinesterase (BChE), commonly known as pseudocholinesterase or non-neural cholinesterase, hydrolyzes neuromuscular blocker agents containing choline esters such as succinylcholine that is widely used in rapid sequence induction (RSI) for general anesthesia. The aim of this study is to compare plasma BChE levels and investigate the affects and relationship of succinylcholine on BChE levels in preeclamptic, gestational diabetic and healthy pregnants.Study designWe designed a prospective, controlled, pilot single-center study. Thirty (n = 30) pregnant women who were scheduled for cesarean section under general anesthesia (refusal of regional anesthesia) with RSI involved. Group 1 included ten (n = 10) preeclamptic pregnancies, Group 2 included ten (n = 10) gestational diabetic (GD) pregnancies and Group 3 included ten (n = 10) healthy pregnancies.Main outcome measuresBChE levels of all patients were measured prior to the initiation of cesarean section. Train-of-four recovery of 90% (TOF T1) was used to monitor the degree of neuromuscular block beginning from the administration of succinylcholine.ResultsNo statistically significant difference was found between the groups comparing BChE levels and the duration between tracheal intubation and formation of TOF T1 (p > 0.05).ConclusionsAs similar results were gathered from normal and high-risk pregnancies (preeclamptic pregnancy or gestational diabetic pregnancy) who underwent cesarean section under general anesthesia, we believe that succinylcholine is still neuromuscular agent of choice in cesarean section.