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Hereditary pseudocholinesterase deficiency discovery after electroconvulsive therapy
  1. Basant K Pradhan1,
  2. Noud van Helmond2,
  3. Ludmil V Mitrev2 and
  4. Angelo A Andonakakis2
  1. 1Department of Psychiatry, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, New Jersey, USA
  2. 2Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, New Jersey, USA
  1. Correspondence to Dr Noud van Helmond; vanhelmond-noud{at}


Inherited pseudocholinesterase deficiency refers to an uncommon defect in the butyrylcholinesterase enzyme which can result in prolonged muscle paralysis due to delayed breakdown of choline ester paralytic anaesthetic agents. We describe a 25-year-old woman receiving electroconvulsive therapy (ECT) for treatment of depression in whom motor function did not recover adequately after administration of succinylcholine. Investigated post-ECT, she was found to have severe pseudocholinesterase deficiency. Implications of pseudocholinesterase deficiency for ECT treatment and anaesthetic strategies are discussed.

  • anaesthesia
  • psychiatry

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  • Contributors BKP prepared the manuscript draft with important intellectual input from NvH, LVM and AAA. All authors edited the manuscript. All authors approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.