Can I use Local Anesthetic on a patient with pseudocholinesterase deficiency?

Gregoire C., JCDA express. Issue 3, March 2011.

Key points:

  • This article provides a comprehensive review of pseudocholinesterase deficiency, including its pathophysiology, genetic basis, available testing and drugs to avoid.
  • A literature review of English-language journals resulted in nearly 250 articles for examination.
  • The authors review acquired conditions, drugs that influence enzyme activity and possible treatments of the disease.
  • They also note a marginally increased rate of pseudocholinesterase deficiency among India’s Hindu Arya Vysya community.
  • The article emphasizes the importance that providers of anesthesia, such as dentists, have knowledge of pseudocholinesterase deficiency.
  • The use of succinylcholine, mivacurium and ester local anesthetics must be avoided in patients with pseudocholinesterase deficiency because these patients may not be able to metabolize such anesthetics.

Reasons for recommending this article:

Pseudocholinesterase deficiency is a rare blood plasma enzyme abnormality that can be acquired or inherited. This disease can be potentially life threatening if not properly identified before certain types of anesthetics are administered. Dentists should be aware of the importance of avoiding ester local anesthetics in patients with pseudocholinesterase deficiency. Although ester local anesthetics are not commonly used in clinical practice in North America, they are often employed when a patient has a suspected allergy to amide local anesthetics or where vasoconstrictors are contraindicated.