Increased Plasma Cholinesterase Activity and Mivacurium Resistance: Report of a Family

1999 
lthough most genetic variants of serum butyryl-choline esterase (BChE; cholinesterase: E.C.3.1.1.8, acetylcholine acylhydrolase) are associ-ated with decreased activity, some rare variants areassociated with increased enzyme activity (2–3 timesnormal) (1–8). These variants have normal dibucaineand fluoride numbers, and the enhanced activity hasbeen attributed to either an increased number of en-zyme molecules (1,2) or increased activity per activesite (3). Resistance to succinylcholine as a result ofincreased plasma cholinesterase activity was de-scribed in four reports (5–8), but neuromuscular func-tion was not monitored.Mivacurium chloride is a bis-benzylisoquinoliniumnondepolarizing neuromuscular blocking drug that ishydrolyzed by serum butyrylcholine esterase (8). Inthis report, we describe the response to mivacurium ina patient with hypercholinesterasemia and the distri-bution of this isozymic variant in her family.
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