Total Intravenous Anesthesia in Combination with Epidural Anesthesia for a Patient with Pseudocholinesterase Deficiency：A Case Report

Abstract

  Anesthetic management of patients deficient in pseudocholinesterase can be problematic because of possible adverse reactions of suxamethonium and ester local anesthetics resulting in prolongation of neuromuscular blockade and local anesthetic intoxication, respectively. We report a case of a 70-year-old woman diagnosed with pseudocholinesterase deficiency who underwent open cholecystectomy under total intravenous anesthesia (TIVA) in combination with thoracic epidural anesthesia. Although the following agents were used for anesthesia management (propofol, remifentanil, fentanyl, rocronium, sugamadex, mepivacaine and ropivacaine), the patient was able to obey commands and was rapidly and safety extubated in a routine fashion after termination of TIVA at the end of surgery. In our case, propofol-remifentanil TIVA with amide local anesthetic epidural anesthesia could be safely performed in a patient with pseudocholinesterase deficiency.