Severe pseudocholinesterase deficiency and ECT: a case report

Pseudocholinesterase (PCE) deficiency is an inherited condition in which recovery from anesthetic agents like succinylcholine and mivacurium is slow and is complicated with prolonged paralysis of respiratory muscles in susceptible patients. We present a very rare case that we encountered in our practice; the patient is a 29-year-old woman with a 15-year history of schizophrenia with pseudocholinesterase deficiency. Since the detection of PCE levels of all patients eligible for ECT is part of our pre-ECT assessment procedure, we could detect the deficiency before the ECT procedure. We performed modified ECT with propophol and rocuronium instead of succinylcholine as usual. Sugammadex was used for fastening the recovery. Response to treatment which is measured with Positive and Negative Symptom Scale was good and we completed 9 ECT sessions without complication. We suggest further investigation of this topic because screening for PCE levels in pre-ECT assessment may reduce complications of modified ECT with anesthesia.