Tukka theek hua.

Question 1

A 60 year old woman has prolonged APNEA after general anesthesia. Plasma cholinesterase activity is abnormal. Which of the following agents is most likely responsible for the prolonged apnea in the patient?

A) Bathenecol
B) Carbachol
C) Dibucuaine
D) Halothane
E) SuccinylCholine

Answer 1

SuccinylCholine!

The duration of action of Succinylcholine is determined by its metabolism by plasma cholinesterase. So if there is abnormal plasma cholinesterase (=pseudocholinesterase), it will lead to delayed metabolism of succinylcholine as well as mivacurium, heroin, and cocaine.

Question 2

Not in the NBME, but related to Succinylcholine. Malignant hyperthermia caused due to succinyl choline is a mutation is _________________.

Answer 2

Voltage-sensitive ryanodine receptors

Please remember voltage sensitive

Question 3

Not in the NBME, but related to Succinylcholine. What electrolyte abnormality is associated with Succinylcholine?

Answer 3

Hyperkalemia—> due to prolonged depolarization of the cell, due to sustained opening of Na-K ATPase pump takes in Na, and gives out K into the synaptic space—-> leading to hyperkalemia.

(increase risk of this happening in burns/muscle trauma)