From the Guidelines
Pseudocholinesterase (PCE) deficiency has no significant direct relationship with Lidocaine (Lignocaine) metabolism, as lidocaine is not significantly affected by pseudocholinesterase 1.
Key Considerations
- Lidocaine toxicity is a concern in patients with poor cardiac output and hepatic or renal failure 1, but this is not directly related to PCE deficiency.
- When using lidocaine in patients with PCE deficiency, it is essential to monitor the patient closely for any signs of toxicity, such as seizures, arrhythmias, or respiratory depression.
- The dose of lidocaine should not exceed 4.5 mg/kg when used for local anesthesia, and the patient should be closely monitored for any adverse effects.
Important Factors
- PCE deficiency may lead to prolonged apnea due to the accumulation of succinylcholine, a depolarizing muscle relaxant, but this is not directly related to lidocaine 1.
- In cases where succinylcholine is used in conjunction with lidocaine, the dose of succinylcholine should be reduced, and the patient should be monitored for prolonged apnea.
- It's crucial to exercise caution and consider the individual patient's condition, medical history, and the specific procedure being performed when administering lidocaine to patients with pseudocholinesterase deficiency.
From the Research
Pseudocholinesterase Deficiency and Its Relationship with Certain Drugs
- Pseudocholinesterase (PCE) deficiency is a condition that affects the body's ability to metabolize certain drugs, including succinylcholine and mivacurium 2, 3, 4, 5, 6.
- This deficiency can be inherited or acquired and can lead to prolonged apnea and paralysis following the administration of these drugs 3, 4.
- The condition is often suspected after a prolonged recovery from paralysis following general anesthesia 2.
Lidocaine (Lignocaine) and PCE Deficiency
- There is no direct evidence in the provided studies that discusses the relationship between PCE deficiency and Lidocaine (Lignocaine) specifically.
- However, it is mentioned that PCE deficiency can also affect the metabolism of ester local anesthetics 4, 5, but Lidocaine is an amide local anesthetic, not an ester.
Clinical Implications
- It is essential for healthcare providers to be aware of the potential for PCE deficiency, especially when using succinylcholine or mivacurium, and to take a thorough medical history to identify patients at risk 2, 4, 6.
- Patients with PCE deficiency may require prolonged monitoring and supportive care, including mechanical ventilation, after the administration of affected drugs 3, 4.